The Role of Thiamin in High Calorie Malnutrition

Objective: A number of disorders have become virtual epidemics in the modern era, including Attention Deficit (ADD), with or without hyperactivity, recurrent ear infections, Autistic Spectrum Disorder (ASD) and obesity. All have male gender preponderance and obesity has been linked to cognitive dysfunction. High calorie malnutrition, defined as calorie yielding foods with insufficient non-caloric nutrients, is common in America. The objective of this review is to show that this type of malnutrition, particularly with the consumption of simple carbohydrate foods, induces thiamin deficiency, often also with magnesium deficiency, providing a common etiological component for these diseases, analogically compared with variations on a symphonic theme in music. Conclusion: High calorie malnutrition is affecting millions of people, involving the inordinate consumption of sugar and fat as empty calories. All simple carbohydrates are metabolized in the body as glucose, with thiamin as the rate limiting factor in the three enzymes that make up pyruvic dehydrogenase and as a cofactor in transketolase. Other non-caloric nutrients are also crucial in oxidative metabolism. Thiamin has been found to be a cofactor in the enzyme 2-hydroxyacyl-CoA lyase (HACl1) in peroxisomes, indicating its role in fat metabolism and the potential clinical effects of Thiamin Deficiency (TD). The phenotype for a mutation in HACL1 has not yet been described although the gene has been mapped to chromosome 3p25. The effect of blocking phytanic acid and long chain fatty acid metabolism and the downstream effect on beta oxidation would be expected to have serious consequences in the brain.