New study links gut bacteria to thiamine's role in reducing fatigue in IBD patients

By Dr. Liji Thomas, MDReviewed by Benedette Cuffari, M.Sc.Sep 11 2024

Research uncovers a potential link between gut bacteria and chronic fatigue in IBD patients, with specific microbes predicting the success of thiamine therapy for fatigue relief.

Study: Thiamine-reduced fatigue in quiescent inflammatory bowel disease is linked to Faecalibacterium prausnitzii abundance. Image Credit: Kateryna Kon / Shutterstock.com

A recent study published in Gastro Hep Advances explores the frequency of symptoms like chronic fatigue in inflammatory bowel disease (IBD) in relation to specific bacteria in the human gut.

Thiamine and energy

Aside from gastrointestinal (GI) issues, chronic fatigue is among the most common symptoms reported by patients with IBD. Low energy, feeling overwhelmed by tiredness, and feeling mentally and physically drained are some aspects of chronic fatigue that significantly reduce the quality of life of affected individuals.

Thiamine, which is more commonly referred to as vitamin B1, is an essential cofactor for multiple enzymatic pathways involved in energy production from the aerobic and anaerobic breakdown of carbohydrates. Thiamine is produced by most microorganisms and plants, but not by vertebrates; therefore, humans derive most of their thiamine from their diet, following which it is primarily absorbed in the small intestine.

Thiamine and butyrate

Thiamine, which is required to synthesize butyrate and other short-chain fatty acids (SCFAs), is an essential factor for bacterial growth and competition. SCFAs like butyrate have potent anti-inflammatory activity.

The primary butyrate producers in the gut are Fecalibacterium species. However, these bacteria do not synthesize thiamine, as they rely on other bacteria or the human host for this cofactor.

Fecalibacterium is among the most abundant bacteria in the gut of a healthy human adult. The prevalence of Fecalibacterium in the human microbiome appears to be age-dependent, as it is found in up to 92% of adults and only 78% of the elderly.

Lower abundances of Fecalibacterium are also observed in individuals with gut disorders, thus making it a potential biomarker of good GI health. In fact, a lower abundance of Fecalibacterium prausnitzii is associated with more severe IBD and the presence of general fatigue in patients with myalgic encephalomyelitis/chronic fatigue (ME/CF).

Gut microbiota and thiamine

Previous studies have suggested that gut microbial diversity, especially that of butyrate producers like Fecalibacterium prausnitzii and Roseburia hominis, and butyrate levels are reduced in patients with chronic fatigue due to ME/CF and those with active IBD.

In one small preliminary study, high doses of thiamine reduced chronic fatigue, which may be mediated by alterations in the gut microbiota. The current study further assessed the role of the gut bacteria in mediating the effect of thiamine in patients with quiescent IBD and severe chronic fatigue.

About the study

The current study included 60 patients with quiescent IBD, 40 of whom also experienced chronic fatigue. The gut microbiota and SCFA levels were analyzed using fecal samples.

The IBD-fatigue cohort participated in a randomized controlled trial (RCT) with a crossover design. The four-week study involved a high dose of oral thiamineto determine its effect on chronic fatigue in these patients.

Changes in microbiota

Patients with IBD exhibited similar microbial diversity, with comparable abundances of butyrate and butyrate-producing bacteria, irrespective of the presence of fatigue. Moreover, thiamine therapy failed to change these parameters.

However, RCT patients who reported relief of fatigue after taking thiamine exhibited more abundant Fecalibacterium prausnitzii and Roseburia hominis in pre- and post-treatment samples as compared with those who did not respond to the treatment. The relative abundances of these microorganisms in pre- and post-treatment samples was negatively associated with the IBD fatigue score in patients with chronic fatigue.

The abundance of Fecalibacterium prausnitzii did not vary significantly in placebo-treated patients who reported a reduction in fatigue.

Conclusions

Fecalibacterium prausnitzii and Roseburia hominis may be useful biomarkers to identify patients with quiescent IBD and chronic fatigue who will respond to high-dose thiamine supplementation. These bacteria species thrive in a healthy gut; therefore, their levels may be used to predict a successful response to thiamine supplementation.

The study findings did not corroborate earlier studies reporting a characteristic difference in gut microbiota profile in patients with quiescent IBD and chronic fatigue. Furthermore, the researchers did not observe an increase in butyrate production by gut microorganisms or butyrate-producer abundance.

The role of thiamine in relieving chronic fatigue is unclear, despite the association between a higher relative abundance of Fecalibacterium prausnitzii in thiamine responders before and after treatment. However, these Fecalibacterium levels did not change with treatment. Thus, future research is needed to confirm these findings and explore the mechanisms involved in these associations.