Intended for healthcare professionals

Practice Pregnancy Plus

Eating disorders in pregnancy

BMJ 2008; 336 doi: (Published 10 January 2008) Cite this as: BMJ 2008;336:93

With Thiamine & Niacin deficiencies, fatigue:depression::dementia:psychosis, which possibly is represented by postpartum depression and postpartum psychosis.

Dear Dr Veronica Bridget Ward and BMJ Editors,

I hope this note finds you well. Congratulations on
such an excellent discussion of eating disorders during Pregnancy,
especially your comment on the
need for Postnatal Support.

My opinion is that fatigue:depression::dementia:psychosis, implying
that, unfortunately,
fatigue and dementia, symptoms of significant Thiamine and Niacin
deficiencies, are sometimes misunderstood
as depression and psychosis.

Be that as it may, I think the sequence of events are thus. If a
female is deficient in Thiamine and Niacin, the first and third B
Vitamines- and possibly the most important, and then experiences a
Pregnancy where the fetus draws all of its Nutrients from the Parturient,
then an eventual worsening of the Pregnant Female's Nutritional
deficiencies might occur. Most importantly I'm referring to Thiamine and
Niacin, but as you know, Nutritional deficiencies are seldom solitary in

For each of the trimesters, the Parturient is all pumped up on the
Hormones of Pregnancy. Some of those Hormones are stimulatory and support
significant Physiological alterations in the Parturient's body.

Despite using Prenatal Vitamines, perhaps because of malabsorption,
supply and demand, etc, the Parturient
might be more deficient in some Nutrients such as Thiamine and Niacin
after the Pregnancy than

After delivering an 8 or 9 pound sack of Vitamines and Nutrients,
known as the Newborn, the
Parturient is supported for only a brief period of time with the elevated
Hormones of Pregnancy
before they normalize.

The Parturient's post delivery levels and availability of Thiamine
and Niacin might be
reduced from pre-Pregnancy levels, which were already below normal.

The timing and the fit seems to be correct to possibly assume that
worsening deficiencies of
Thiamine and Niacin now contribute as root causes of post partum fatigue
and dementia. That particular situation, unfortunately, in my opinion, is
often interpreted as post partum depression and postpartum psychosis.

Wouldn't it be terrible if those sorts of diagnoses could be treated
with a ten cent over the counter 500 mg Thiamine tablet, with results in
six hours, or a Dollars worth of a single pill of 750 mg of Niaspan SR
(Niacin Sustained Release), but that particular Clinical Empirical
maneuver wasn't even thought of as a possibility. Measuring serum levels
for Thiamine and metabolite ratios for Niacin certainly couldn't be

Lastly, I love the Passion of Drs Singh and Emanuele Cereda, as is
evident in their Comments.

During a Medical School Nutrition Course here on this side of the
Pond in the United States, I mentioned that a teenage female who became
anorexic and purged herself down to about 80 pounds over a several year
period, might have experienced dementia since there are only 45 mg of
Thiamine stores in the body. She would have gone through that, at 1.5 mg
MDR/day in 30 days. Because of gluconeogenesis, the body always needs
Thiamine, which is used in carbohydrate metabolism at the rate of about
750 micrograms/1000 Calories of diet.

Then the demented body image could be explained as an expression of a
Wernicke's Encephalopathy or the dementia of a Niacin deficiency. I've
always thought that concept of a distorted body image to be unusual. That
distorted body image concept could be a symptom of a Thiamine and/or
Niacin deficiency.

When the Patient is skinny as a rail, she still thinks of herself as
overweight, or that her body
proportions aren't correct. Perhaps the Patient feels that she is far
removed from the "Golden Ratio" and that is what the female is really
referring to, saying that her body image is wrong.

Since the beauty of the Golden Ratio is a naturally occurring thing,
perhaps the Patient's awareness of its lack of presence could be a
subconscious thought or opinion of herself.

At any rate, another corollary of mine, could be described as, "If
the Parturient is deficient in a Nutrient, can the neonate be anything
but, ie, have reduced levels for the same Vitamin, Mineral, etc, which
should make excellent food for thought for all of us.

Best wishes always. Keep up the good work.

Remember the most important quote of a Nobel Prize Winner,
"Imagination is more important than Knowledge."


Joseph W Arabasz MD

Past Division Chairman, Anesthesiology, Cook County Hospital,
Chicago, Illinois

Past Chairman, Respiratory Therapy, Cook County Hospital, Chicago,

Diplomate ABA


Sigma Xi, The Professional International Science Research Society

PO Box 6939

Denver, CO 80206



Competing interests:
None declared

Competing interests: No competing interests

26 February 2008
Joseph W Arabasz MD
Joseph W Arabasz MD PC 80206