Frequently Asked Questions from Dr. Costantini's website

Please click the following link to view the 60+ questions/answers posted on Dr. Costantini's website. Click here.

Or view as a pdf here

Common Questions

Below are some of the more common questions posted on forums by new users of this therapy.

A. What is the recommended starting dosage of thiamine?

This is the most common question asked on forums and groups. There is no exact science for dosing. Everybody is different. Thiamine is generally considered as safe but please pay close attention to how you feel starting around the 4th day. 

Users who reported the most success averaged around 2000 mgs/day split into AM and PM doses. Some users started off at this high dose and saw improvements within 5 days. But it is generally recommended to take a slower, more gradual approach listed below.  

Week 1:

  • Start at 25 - 500 mg/day, split between morning and early afternoon. After 5 days, evaluate how you feel. Are you jittery or have your symptoms worsened? 

Week 2:

  • If you felt fine from previous amount, double the dosage. After 5 days evaluate how you feel.
  • If you felt worse during week 1, take 50% less. After 5 days evaluate how you feel.

Continue increasing or decreasing each week as needed. When your symptoms worsen or you feel jittery, go back to the previous amount and maintain that dose. 

To go very slowly, rather than increase every week, stay at the same dosage for a month before increasing during the second month.

B. Should thiamine be taken with food?

It can be taken on an empty stomach or with meals split between morning and early afternoon. Best to take away from coffee, tea or juice.

C. Where can I get the recommended type and dosage of thiamine?

  • Vitacost - *Recommended* These easy to swallow 500 mg capsules are the popular choice for patients using this therapy: Click here.
  • Amazon - 500 mg capsules are large and could be a problem swallowing: Click here.
  • Bulk Supplements - no additives powder. Click here. 

D. What improvements can I expect?

Many users reported improved balance and more energy as the first signs of improvement, often within the first week, but your mileage may vary.

There have been 80+ reported improvements in this forum article: Click here.

E. How does high dose thiamine work?

Most patients responding positively to this therapy are not nutritionally deficient in thiamine. Instead, this therapy works at the cellular level to reduce oxidative stress and this allows a key enzyme involved in mitochondrial energy metabolism called alpha ketoglutarate dehydrogenase (KGDH} to reactivate. Thiamine is one of the key cofactors used by this enzyme and if there are insufficient levels in the cells, it limits succeeding brain functions from working properly, leading to neurodegenerative diseases. High doses of thiamine restores the activation of KGDH and allows for improved brain function.

EONutrition has a video explaining this in depth. Click here for the video.

F. What if I don't have any improvement in my PD symptoms?

The improvements can happen slowly. If you viewed Dr. Costantini articles and videos, he recommends recording yourself before starting this high dose therapy so that you can compare your symptoms before and after. 

  • Give it some time. While some people may see changes within a week, it may take up to a month before you see improvements.
  • Try taking the thiamine dose away from food, coffee, tea or juice. Food and the acidity/tannins can interfere with absorption. 
  • Avoid alcohol, as it may interfere with the absorption of thiamine.
  • Talk to your doctor about getting intramuscular injections. This method increases effectiveness by bypassing the digestive tract.
  • Increase the dosage up to 4000 mg/day, if tolerated.
  • Try adding magnesium supplements to aid in the absorption of thiamine. 
  • This therapy may not work for everyone.