If you suspect you have Parkinsonism or Parkinson's Disease, please seek the help of a medical professional. You should also discuss the Vitamin B1 Thiamine therapy in this document with your neurologist or doctor. This guide is for educational purposes only.

Please leave a comment with any questions you may have.

Introduction

Parkinson's is a degenerative neurological disease. That means it affects the brain and nervous system and gets worse over time. Given this, there is a critical need to stop its progression and help patients regain skills as soon as a diagnosis is made.

As of now there is no cure for the disease but there is a treatment available, based on the work of Dr Antonio Constantini, which is relatively cheap, safe, and could improve your life considerably. It is called the High-Dose Thiamine (Vitamin B1) Protocol. Thiamine is the alternative name for Vitamin B1.

Your neurologist, doctor, or Parkinson's specialist nurse are unlikely to have heard of this treatment. This guide has been written to help people like you and health professionals alike understand the effects of thiamine on the Parkinson brain and explain the therapy to those who wish to start the programme.

Dr Constantini passed away in 2010 after contracting the SARS-CoV-2 virus. Fortunately, his work continues in the people using this treatment and through his colleagues who are have  established a fund to help complete his research. You can donate to the fund at https://www.gofundme.com/f/high-dose-thiamine-protocol

Current treatments for Parkinson's

Levadopa has been the go-to choice for the treatment of Parkinson's symptoms since 1961. It is often referred to as the "gold standard". It is available under various brand names including Sinemet (levodopa and carbidopa) and Madopar (levodopa and benserazide). They are both versions of levadopa combined with a carrier to help more of it get into the brain.  A natural source of levadopa can also be found in Mucuna Pruriens for those who can't tolerate Sinemt or Madopar.

There are other therapies used with or without levadopa such as:

• Amantadine
• Dopamine agonists (Roprinirole, Rotigotine patches)
• MOA-B inhibitors
• COMT inhibitors

They are no good alternatives to levadopa and none of them (including levadopa itself) can stop the progression of Parkinson's. They can cause side-effects such as respiratory and motor dyskinesia where breathing and movement become involuntary or abnormal. This could be more frightening and debilitating than the symptoms they are intended to relieve.

The HDT Protocol

This treatment can be applied by anyone with Parkinsonism no matter what stage they are at. 

Vitamin B1 is the first of the eight B vitamins to be found. It is only stored in the body for a short amount of time and is excreted through urine. It is a well-known supplement in the medical field and often used to help treat alcoholics.

High-dose Thiamine protocol aims to keep the levels of thiamine constantly high in the body. The dosage is so high that it forces cells to become stimulated and restore their functionality. Despite the dosage being far higher than normally taken to correct a vitamin deficiency, there have been no reported side-effects in the regular use of high-dose thiamine.

Be mindful that high-dose thiamine therapy is not a cure. That means it must be taken consistently throughout your life otherwise your symptoms are likely to return.  Dr Constantini used the high-dose B1 protocol in conjunction with other existing Parkinson's medications, namely levadopa. He didn't instruct patients to stop taking their usual medications despite an improvement in symptoms after beginning high-dose B1.

What type of vitamin B1 (thiamine) is used for treating Parkinson's? 

This is simple. The only ones allowed for the HDT theraphy are:

• Intramuscular injections
• B1 Hydrochloride (HCL) capsules or powder
• Sulbutiamine capsules or powder

IM Injections

Injections are the most powerful as they bypass the digestive system and is the form of thiamine that was administered by Dr Constantini. 

B1 by injection acts quickly and doesn't require swallowing lots of bulky capsules. However receiving injections of B1 is not available to most people on a regular basis and it is unlikely you will know how to administer the injection yourself. Thiamine injections are not recommended for people taking with anticoagulants to prevent blood clots e.g. rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis), edoxaban (Lixiana).  

Oral B1

Vitamin B1 is easy to buy in most stores and online, however they are not equal. The only forms that can be taken for the high-dose theraphy protocol are:

• Vitamin B1 Thiamine Hydrochloride (HCL)
• Sulbutiamine

Sulbutiamine dissolves in fats and is easily absorbed by the body. It is the most expensive of the oral supplement options but more powerful than B1 HCL. Due to its increased potency, you can take less of it to get the same effect as B1 HCL. However you must be careful not to overdose on fat-soluble vitamins as excess amounts are stored in fats and not flushed out.

However, Dr Constantini's preferred choice for oral administration was B1 HCL. This is probably because it is water-soluble, cheaper to buy, and is more widely available on the market. Being water-soluble means any excess amounts will be safely passed out in the urine so there is no fear of overdosing.

Whichever option you go for, make sure the capsules or powder you buy do not contain any other vitamins or ingredients such as magnesium. It must be pure B1 Hydrochloride (HCL) or Sulbutiamine only. 

We recommend these products as meeting the correct specifications:

• Vitacost 500mg Vitamin B1 HCL
• Double Wood Sulbutiamine 200mg

Intramuscular injections dosage guidelines

The starting dose is 1 x 100mg per week. If symptoms improve it can be increased to: 

• 2 x 75mg injectable solution per week
• 2 x 100 mg injectable solution per week
• 2 x 100mg injectable solution twice per week

The highest does is therefore 2 x 100mg injections of thiamine solution twice a week. The intramuscular injections must be performed by qualified professionals in order to avoid bruising the area.

Oral Vitamin B1 HCL guidelines

The dosages here are not strict and you are free to adjust them accordingly. However we provide a range that is considered to achieve therapeutic effect and are likely to give the greatest benefit. The oral dosage is around 140 times higher than intramuscular injection as much of the B1 is lost in the digestive system and by the processing of the liver.

Only use Vitamin B1 HCL and avoid other variants

Do not use any other derivatives of thiamine such as B1 mononitrate, bentothiamine, or sublingual B1. 

Bentothiamine doesn't cross the blood-brain barrier, mononitrate can cause kidney stones, and a sublingual B1 does not exist. What does exist is something called "microlingual" B1 which is being marketed as a sublingual version of B1 when it is nothing of the kind. It is based on B1 mononitrate and doesn't cross the blood-brain barrier.

Any drug, spray, or liquid that is sublingual means it can be placed under the tongue and the substance will directly enter the bloodstream – bypassing the digestive system and liver. However, only certain substances can be administered in this way and vitamin B1 is not one of them. Simply dissolving a tablet in your mouth does not make it sublingual. It has to have the correct properties to be able to enter the bloodstream from under the tongue

Test of allergic reactions

The initial two weeks should start at 500mg per day. This is a low dose (although you can get lower) to test for any allergic reaction to B1 HCL. You may even find some improvements in your symptoms, such as less fatigue, at this stage. Only move to the next stage if you are not allergic to B1. 

The following stages are suggestive because each person is different in their size, weight, and genetics. There will be no improvements if you take too little and a potentially a temporary worsening of some symptoms or becoming jittery and anxious if taking too much. It's a trial-and-error exercise but the following is a good method to follow.

Start at 2g across the morning and afternoon

Take 2g of B1 HCL per day split into two:

1. 1g (2 x 500mg capsules) in the morning
2. 1g (2 x 500mg capsules) in the afternoon

The only reason a morning and afternoon dose is given is because some patients reported disturbed sleep after taking B1 in the evening. It is perfectly fine to take a dose in the evening if you want to.

2g is the middle dosage from which you can increase to 4g or even 8g if necessary. Some people may reduce their dose to 1g or 500mg, but such low doses are not thought to achieve therapeutic benefits.

Continue this starting dosage for 6 weeks.

Stop and restart if symptoms worsen

If your symptoms get worse, stop taking B1 for a week, and then restart at half dosage. That is, 2g will become 1g with 1 x 500mg taken in the morning and 1 x 500mg in the afternoon.

Increase dosage to 2g/4g/6g if symptoms do not improve

After 6 weeks your symptoms might have improved considerably. Your facial expressions, mood, and energy levels might be better. At this point you can either:

• Stick to the current working dosage
• Increase the dosage by 1g

Increasing the dosage may help improve symptoms further, but you should only increase slowly to avoid overdosing and causing unwanted effects such as feeling jittery, anxious, or any other side effects.  This is called titration.

1g is a good step up on the titration ladder. Stick to the new dosage for 6 weeks before increasing again to reach 4g daily.

The 2g/4g/6g thresholds

How much to take can roughly be summarised as:

•  2g is for early-stage Parkinson's with mild symptoms
• 4g for mid-stage Parkinson's
• 6g for late-stage Parkinson's with severe  symptoms

According to Dr Constantini's studies, patients see the most benefit at 4g daily, however this doesn't take into consideration the person's weight, duration of the disease, or severity of the symptoms. 

You may not need to go as high as 6g or may need to go even higher than 6g depending on your sensitivity to the therapy. 8g daily is not unheard of but it means swallowing a lot of pills. 

How to avoid overdosing

The 'correct' dosage for you is when the majority of your symptoms have improved with no unwanted side effects. You should hope to see almost all of your non-motor symptoms supressed and your movement functions improve by 50%. Taking higher amounts beyond this point may result in unwanted symptoms of overdose.