Biochemistry of Thiamine and Glucose Utilization
"Diabetes might be considered a thiamine-deficient state"
Some Boring Biochemistry - For Health-Care Professionals
If you are not a technical person, you might want to skip this section.
What is Thiamine ?
Chemical structure of Thiamine Triphosphate (TPP) by Wikimedia Commons
Thiamine acts as a coenzyme for the transketolase enzyme (TK), which shifts excess fructose-6-phosphate and glycerhaldeyde-3-phosphate from glycolysis into the pentose-phosphate shunt, thus eliminating these potentially damaging metabolites from the cell. An excellent description of this pathway can be found here.
Thiamine is a cofactor for two important enzymes, the pyruvate-dehydrogenase complex (PDC) and alpha-ketoglutarate dehydrogenase (AKGD) enzymes, which are fundamental for intracellular glucose metabolism.(4)
here. For those who forgot their medical school biochemistry, an excellent description of Citric Acid cycle can be found here. Another good explanation of the Citric Acid Cycle here.
Thiamine Reverses Renal Complications of Diabetes (5)
"Thiamine supplementation may prevent and reverse early-stage diabetic nephropathy."
Thiamine supplementation prevented the development of early-stage nephropathy in diabetic rats and reversed increased urinary albumin excretion in patients with type 2 diabetes and microalbuminuria in two recent clinical trials.(5)
A 2009 Double-Blind Clinical Trial of High-Dose Thiamine
In a 2009 study published in Diabetologia by Dr Rabbani from Warwick Medical Center, 300 mg thiamine per day in diabetic patients produced regression of micro-albuminuria (early diabetic renal disease). This was a pilot study of 40 patients with type 2 diabetes over 12 weeks(6). A later study from the Netherlands using Benfotiamine, a lipid-soluble form of thiamine, did not find any improvement in proteinuria in spite of higher blood thiamine levels.(6A) Whole-blood thiamine levels in 40 patients increased from 126 (baseline) to 300 nmol/L after 12 weeks of Benfotiamine.(6A)
An excellent review article by Dr Page was published in the 2011 issue of the International Journal of Clinical Practice, entitled "Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease".(10)
Dr Page clearly links thiamine deficiency with the progressive atherosclerosis disease commonly found in diabetic patients with "metabolic syndrome". Dr Page writes:
"Individuals with diabetes are thiamine deficient. The pathophysiology of recognised complications of thiamine deficiency is similar to that underlying atherosclerosis and the metabolic syndrome, namely oxidative stress, inflammation and endothelial dysfunction...