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July 17, 2003

Alternative Therapies and Explanations

Question from LaGrange Park, Illinois, USA:

A website called Benfotiamine.net has abstracts from medical journals about research done with this vitamin, and it looks promising. Have you heard of benfotiamine? What do you think of people with diabetes taking this substance?


Benfotiamine is a synthetic thiamine derivative that become popular in Germany for the prevention of the complications of diabetes. (See Hammes HP, Du X, Edelstein D, Taguchi T, Matsumura T, Ju Q, Lin J, Bierhaus A, Nawroth P, Hannak D, Neumaier M, Bergfeld R, Giardino I, Brownlee M. Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathy.. Nat Med. 2003 Mar;9(3):294-9.) It is available as a food additive in the US, but like a number of other similar products is not part of orthodox management of any form of diabetes, except perhaps some of the very rare cases of mitochondrial diabetes.

This is not to deny that it may have a role or to say that the placebo effect of making a personal contribution to your diabetes management is not of value, but rather to stress that the important issue is to do everything you can within conventional limits to keep your blood sugars as normal as possible and your hemoglobin A1c within normal limits.

Additional comments from David Mendosa, A Writer on the Web:

I have written about benfotiamine on web pages as follows:

In my on-line newsletter, I wrote:
We now have real hope to prevent — but not cure — diabetic retinopathy. Five researchers at three German universities and two in the United States have found that something called benfotiamine blocks three of the four major pathways leading to damage from the most common form of diabetes-related eye disease.

Rats with diabetes that were treated with this synthetic form of Vitamin B1 for 36 weeks did not develop any of the retina damage found in a similar group of untreated rats. Although benfotiamine has been widely used to prevent diabetic retinopathy in Europe for more than a decade, there are no double-blind clinical trials in humans. The could, however, start within a year. The study appears in the February 18 advance on-line edition of Nature Medicine.

Already the entrepreneurs are getting into the act. One Canadian company says on a diabetes-related newsgroup that it is rushing to “make pharmaceutical-grade benfotiamine available to North Americans.”

Since the press nowadays rushes to report the least significant study as a major breakthrough, I wanted to hear what the author of the best book on diabetic eye disease had to say. So I wrote Dr. Paul Chous, whose book Diabetic Eye Disease: Lessons from a Diabetic Eye Doctor is due out this month or next. I reviewed it in Number 54 of this newsletter and it is on-line.

“For more than 30 years, scientists have known of four biochemical pathways responsible for the blood vessel damage that causes many diabetes complications, ” Dr. Chous replied.”This study shows that benfotiamine completely blocked three of these four chemical pathways…. Drugs designed to block just one of these four, harmful biochemical pathways currently are being developed (e.g., PKC inhibitors).”

I answered back questioning what could block the fourth pathway.”The fourth pathway may, in fact, be affected by benfotiamine. According to the study’s lead author, their team has not isolated and studied that pathway vis-�-vis benfotiamine.”

I also wondered if benfotiamine could cure as well as prevent retinopathy.”It might reverse the earliest stages, but once ‘capillary closure, ‘ infarction (death) of retinal tissue and neovascularization are underway, I would not expect this therapy to reverse these processes, as a multitude of other biochemical pathways will be involved (i.e., the horse is out of the barn). Only time (and research) will tell, though.”

As a way to prevent this awful complication of diabetes, benfotiamine sounds wonderful. You can, however, take too much of it, so taking it without a prescription is a bad idea. Dr. Chous points out that unlike thiamine, which is water soluble, benfotiamine is fat soluble. Excess amounts of vitamins that are water soluble are eliminated rather easily in the urine. But fat soluble compounds are not. While that undoubtedly increases the retention and effectiveness of benfotiamine, that means it is potentially harmful in excess.

That information is summarized at On-line Diabetes Resources Part 16: Diabetic Retinopathy.

At On-line Diabetes Resources Part 15: Diabetic Neuropathy, I wrote:
Numerous clinical trials have demonstrated that Benfotiamine is effective at reducing the pain of diabetic neuropathy, and no side effects or signs of toxicity have emerged. Based on these trials, Benfotiamine has been approved for use as a therapy for neuropathy in Germany for more than a decade. Furthermore, Benfotiamine is not just an pain killer, but actually improves nerve functioning. Free on-line abstracts of Benfotiamine studies include “Effectiveness of different benfotiamine dosage regimens in the treatment of painful diabetic neuropathy”, “Therapeutic efficacy of ‘Milgamma’ in patients with painful diabetic neuropathy,” and “A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy.”