Thiamine Deficiency & High-Calorie Malnutrition: Could Hidden Nutrient Deficiencies Be Why You’re Still Sick? | E189

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Back-to-School 2026:
https://richmondfunctionalmedicine.com/lp/back-to-school-2026/
In this Made for Health solo minisode, Dr. Aaron Hartman continues asking the question at the center of this series:
Why are you still sick? Why are you stuck even after addressing Lyme disease, mold, MCAS, gut dysfunction, nervous-system dysregulation, and other potential drivers?
This time, Dr. Hartman looks at something much more fundamental: Are you actually getting—and using—the nutrients your cells need?
He explores thiamine, or vitamin B1, deficiency, including the possibility of milder functional deficiencies that may not resemble classic severe beriberi but could still overlap with symptoms such as fatigue, neurological complaints, dysautonomia, and POTS. He then expands the conversation to a larger concept: high-calorie malnutrition, where someone may consume plenty of calories while still being deficient in vitamins, minerals, and other micronutrients required for normal cellular energy production.
For Dr. Hartman, this raises another important possibility for people who have made progress but still feel stuck:
What if part of the problem is not another disease—but a body that simply does not have enough of the raw materials it needs to function well?
Key Topics Covered
Why nutrient deficiencies may be overlooked in chronic illness
Thiamine, or vitamin B1, deficiency
Functional versus severe nutrient deficiency
Wet and dry beriberi
Thiamine and neurological function
Thiamine and cardiovascular function
Dysautonomia and POTS
Chronic fatigue and fibromyalgia
Mitochondrial dysfunction
Cellular energy production
Why some patients may respond to B1 supplementation
The concept of high-calorie malnutrition
Processed food and micronutrient density
B-vitamin deficiencies
Magnesium and potassium
Vitamin D
Omega-3 fatty acids
Micronutrients and the Krebs cycle
Why calories alone do not equal nutrition
Food fortification and nutrient loss from food processing
IV vitamin C and the additional nutrients often included with it
B-complex vitamins
Nutrient testing in complex chronic illness
Why rebuilding nutrient status may take time
Returning to foundational nutrition and real food
In This Episode, You Will Learn
✅ Why Dr. Hartman routinely evaluates thiamine and other nutrient levels in complex patients
✅ How vitamin B1 deficiency can affect the nervous system, cardiovascular system, and energy production
✅ Why some symptoms associated with POTS, dysautonomia, chronic fatigue, and neurological dysfunction may prompt him to consider nutrient status
✅ What Dr. Hartman means by high-calorie malnutrition
✅ How someone can eat plenty of food while still lacking essential vitamins and minerals
✅ Why heavily processed carbohydrates may increase metabolic demand while providing fewer of the micronutrients needed to process them
✅ Why mitochondria require multiple vitamins and minerals to efficiently produce cellular energy
✅ Why feeling better after a multivitamin, B-complex, or nutrient replacement may sometimes provide an important clue
✅ Why improving one nutrient may not be enough if several deficiencies are present
✅ Why Dr. Hartman keeps returning to the same foundational recommendation: eat real, nutrient-dense food
Resources & Links:
🌐 Dr. Aaron Hartman – Richmond Functional Medicine: richmondfunctionalmedicine.com
🌐 LinkedIn – Dr. Aaron Hartman: Connect Here
📺 YouTube – Richmond Functional Medicine: Watch Here
🎒 Back-to-School 2026: Back-to-School Bundle
Mentioned in this episode:
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