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Art (California) on 12/10/2025: 
I have decided to make this post as a general guide to explain how Dr. Costantini tried to determine the correct B1 dose for each of his patients via email. By doing this, I won't have to write it again when anyone asks about HDT dosing, just refer them to this reply.
My hope is that this page will answer many questions, for people considering B1, about HDT/B1 supplementing.
Forum, members have found effective daily dosing as low as 25 mg/day or as high as 5, 500 mg / 5.5 grams per day, but the majority are well below 4, 000 mg/day.
Dr. C would start his email patients at 4 grams in two divided doses per day, half the dose at breakfast and the other half at lunch with or without food in the beginning. At the beginning of first treating his patients by email it was 4 grams for everyone, but later he began starting them at lower dosing once he realized that 4 grams was too much for most people and people who weighed less and or had minimal symptoms. He still tried to start them on the high side in order to see if he could elicit a faster response, so in a case of a patient who weighed 150 pounds, he might start them at 2, 000 mg or 3, 000 mg and have them report back to him regularly how they were doing.
If there was a noted improvement, but then the improvement was followed by a loss of the new improvement and possibly a worsening of symptoms to as much as worse than ever before, he would have them stop B1 for 3 to 5 days and have them take meticulous notes during this time without B1. Dr. Costantini said that in his many years of experience with HDT, any new symptoms or worsening of symptoms that were brought on by too much B1, were only temporary and were soon resolved once the dose was lowered appropriately. He almost always used a 3 to 5 day break from B1 before restarting at a new dose.
What he was looking for was to see how quickly you lost the increased symptoms and how long it took you to return to your base starting condition. He also required that his patients take videos at regular intervals of themselves doing common things like walking, talking, writing, going up and down stairs putting socks and shoes on etc. He only required short videos because he was very adept at determining the overall condition of the patient and these videos helped him determine any changes that might be attributable to B1. He only required a 1 to 3 minute video, but I suggest taking longer 5 minute videos to make it easier for a lay person to determine changes from baseline, easily.
After the patient had stopped B1, the worsened symptoms had gone away and 3 to 5 days had passed, he would restart his patient at, often times, half the dose they had been taking, but this could vary for each individual. For example, if you lost the increased symptoms very quickly such as by the next morning after stopping B1, that would tell him that the original dose was close, but a bit on the high side and in such a case he might only take the patient down to 2, 500 mg or 2, 000 mg instead of 1, 500 mg (half) from the original 3, 000 mg. On the other hand, if it took a full five days to get back to your pre B1 symptom level, that was an indication that the dose was significantly too high in which case he would halve the dose from 3, 000 mg to 1500 mg.
It should be mentioned here that Dr. Costantini also required a regular video of the pull test as part of his patient requirements. The pull test helped him to determine an optimal dose. A good pull test in conjunction with significantly reduced symptoms was his way of determining when the B1 dose was optimized. Being a neurologist, he might also try and optimize the levodopa dose at this point also if the patient was already using levodopa. He encouraged patients to use both levodopa and B1 as the best chance to minimize motor symptoms, but some on this forum have achieved good results by using the herb, Mucuna Pruriens in place of levodopa, but that is another topic all by itself. Here is a link to the pull test of a person with a poor response as performed by Dr. Costantini:
https://youtu.be/Ijf326ZNAoU?si=GHCHSilsfGj_Z6eT
Here is a link to a person with a better response as performed by Dr. Costantini :
https://youtu.be/YEejV3NmY98?si=6pKklt84PKT-2Hfd
I am only giving this information as a general guide to how Dr. Costantini was determining dosing of B1 for his patients. This is not a specific dosing method for anyone, just a general idea of Dr. Costantini's dosing methodology.If you are one of the lucky ones that respond to B1, I would like to point out that Dr. Costantini felt that once you found your correct dose, that dose should be good for quite awhile, but he also found that in the 6 month to 18th month of HDT use, it may be required to take a short vacation from B1 and or reduce the dose very slightly. You will find that many members have adopted this thinking into their B1 regimen. Some take a brief break from B1 if they find their symptoms worsening and then get back on B1 with no change in dose, once their worsening of symptoms have subsided, while others take a break from B1 until the increased symptoms depart and then resume at the same dose, but reduce the dose slightly by taking one day of the week (the same day each week) off from B1. As you can see, dosing B1 can be very individualized and there is not and has never been one method or dose that fits everyone. The fact that the reported effective dosing reported on this forum is 25mg to over 4000 mg per day is a testament to the fact that one dose does not fit all. Lastly, it should be made clear that although the majority of patients respond to HDT, there are some who simply do not respond to B1 and there are some who take up to 6 months to finally respond to B1. Dr. Costantini felt that even a bad response meant that you could also be a positive B1 responder, but on that point, I am not clear because there is not enough feedback on this HU forum to verify that point.
Art
Peachie (Wisconsin USA) on 01/04/2024:
Sorry, thanks!
Karen (Iron Station, NC) on 01/07/2019:
Karen (San Diego, Ca) on 09/28/2018:
I was diagnosed with PD in 2010 at age 50. I managed to continue work for six years but struggled to do my job in that 6th year which was extremely stressful. Trying to hide my diagnosis was additional stress. Having to stop working only increased my depression and anxiety. I am single and live alone and was struggling with day to day activities. I envisioned my future as residing in a nursing home. I found little relief from PD medications and only experienced new problems from their side effects. I was given more medications to treat the side effects.
I feel like a different person now. Still far from who I was before PD but now I can do my daily activities slowly and no longer suffer anxiety, off the Xanax I took for 3 1/2 years, and minimal depression. I get the blues on occasion. I only take Selegiline 5mg twice a day as a prescribed medication. I was prescribed 7 medications previously.
I started high dose B1, Thiamine, June 2018, taking 1/4 teaspoon in water, twice a day. I did not notice any change in my symptoms. I increased it to 1/2 teaspoon in water, twice a day, still no change. I continued taking it anyway. I then purchased capsules, 500mg. I take two, twice a day. I started noticing that I was using my right hand for things I could not do before. The changes have been subtle but to me significant, giving me hope. I have more energy and feel more alive. My movements are more fluid.
I must add that I also changed my diet. I have been vegetarian since I was 16 but now I am, or try to be, gluten free, dairy free, plant based diet. I suffer chronic pain and wanting to decrease inflammation. I also added the use of low level red light therapy. Not sure what is working but I feel I have turned a corner and instead of declining I feel I'm improving, very slowly.
Thank you.
Hashiaussie (Melbourne) on 08/02/2018:
I am not sure if I read about Vitamin B1 here on Earth Clinic or on Dr. Mercola's site. I know it was just a casual mention. Either way, about 18 months ago I told my husband (qualified in brain science) about its potential usefulness for my mother-in-law who has Parkinsons. He researched Dr. Constantini (using Google translate) and with my mother-in-law's specialist's OK put her on 200 mg orally at 8 am and another of the same dose at midday - every day. The specialist now says my mother-in-law is the best improved of all of his patients after treating her for at least a decade. She is on a walker, lives alone, still cooks, cannot bend over so has council cleaners and family to shop. From being depressed at the age of 88, she is now alert and sociable. She is clearly less affected by the disease and less focussed on restlessly awaiting the next timed dose of the standard Parkinson's treatment (which she still takes). My husband says her specialist has noted a reduction in tremor and other symptoms(previously debilitating).
The vitamin comes in 100 mg tablets from a common supplier (so 2 at a time) and is available from any chemist here. No 'special' brands appear to be necessary. My husband worked out the dose from looking at the research and did not consider her status - he just reviewed the trials. It was understood at the time that the dose could be variable so we may have just been lucky to gain improvement at the first attempt. It was clear after a few weeks that she was brighter and happier. We have suggested to the partners of friends similarly affected that it might be worth a try even sending copies of the research. While the specialist we deal with is open to science, it seems some are not. In our case, I think my husband's grasp of the jargon and brain research helped. He attends every appointment with his mother so there was also a shared endeavour in looking for ways to improve. We had previously found that if she painted, the repetitive movement cancelled out the tremor for a while so there was already credibility and trust with the specialist. Keeping written diaries of symptoms also assists.
I sincerely hope that others reading this will investigate this information themselves and take action with medical help.
I have watched members of my family die and suffer from de-generative brain diseases. There is more information available now and we and our doctors should all take note.
Thank you to Earth Clinic for providing this invaluable resource.
