What is Vitamin B1 (Thiamine) Deficiency?
Vitamin B1, also known as Thiamine, was the first vitamin discovered many years ago. It plays a key role in creating energy in our body by interacting with certain types of proteins and acids. Thiamine also assists with brain-related functions, such as the transmission of nerve signals and maintenance of the myelin sheath, a covering that protects our nerves.
This vitamin dissolves in water and is found in several types of food. Foods rich in Thiamine include meat (such as beef and pork), legumes, whole grains, and nuts. Processed foods like milled rice and grains, however, have less Thiamine because the vitamin is removed during the manufacturing process. Moreover, certain foods like tea, coffee, raw fish, and shellfish contain enzymes that can destroy Thiamine.
If the body doesn’t have enough Thiamine, it can potentially affect your heart, nerves, and immune system. This deficiency is often seen in disorders like wet beriberi, dry beriberi, or Wernicke-Korsakoff syndrome. These conditions are mainly found in populations where polished rice and milled cereals are a primary food source and in people who misuse alcohol. Dry beriberi may result in a disease that damages peripheral nerves leading to weakness and numbness, while wet beriberi can lead to heart failure. Wernicke-Korsakoff syndrome can bring on symptoms such as changes in how people walk, confusion, and eye disorders.
What Causes Vitamin B1 (Thiamine) Deficiency?
Thiamine deficiency can happen for several reasons:
Sometimes, it’s due to not getting enough thiamine in your diet. This can happen if you frequently eat foods like white rice or processed grains, if you drink alcohol excessively, or if you’re getting your nutrition through an IV that doesn’t contain enough thiamine. Gastric bypass surgery can also lead to a low intake of thiamine.
Other times, it’s because your body doesn’t absorb thiamine well. This can occur if you’re malnourished, have had a gastric bypass surgery, or suffer from a disorder that makes it hard for your body to absorb nutrients.
Increased loss of thiamine can also lead to deficiency. This might happen if you have diarrhea, excessive vomiting during pregnancy, if you’re using diuretics, or receiving kidney replacement therapy.
Your body’s need for thiamine can also increase at certain times or conditions, and if you don’t get enough of it, you can become deficient. This can happen during pregnancy, while breastfeeding, if you have an overactive thyroid, or if you’re recovering from a period of malnourishment.
Certain drugs, especially diuretics, can also cause your body to become deficient in thiamine.
Risk Factors and Frequency for Vitamin B1 (Thiamine) Deficiency
Thiamine deficiency is a global problem, mainly caused by not getting enough of this nutrient from the diet. This is often the case for people who eat a lot of polished rice and grains. In Western countries, it’s most often seen in people who have alcoholism, or long-term illnesses. Other groups that are more likely to have thiamine deficiency include:
- Pregnant women
- People who need to be fed through their veins because they can’t eat normally
- People who have had weight loss surgery (bariatric surgery)
- People who aren’t getting good overall nutrition
- Patients who are taking water pills (diuretics) regularly, because these medicines increase the loss of thiamine in the urine
Note that when women don’t get enough thiamine, it can cause a disease in their babies called infantile beriberi. This article won’t go into detail about that issue.
Signs and Symptoms of Vitamin B1 (Thiamine) Deficiency
Thiamine deficiency can occur due to a variety of reasons such as inadequate nutrition, excessive alcohol consumption, or in certain high-risk individuals like pregnant women, those undergoing weight loss surgeries, patients on long-term water pills, or anyone experiencing overall poor nutrition.
The onset symptoms of this deficiency, also known as a lack of Vitamin B1, often include loss of appetite, mood swings, and issues with short-term memory. If left untreated, thiamine deficiency can further result in loss of sensation in the hands and feet, symptoms similar to heart failure like swelling of the hands or feet, chest pain, or experiences of dizziness, double vision, and memory loss. Observations from close friends and family about the person exhibiting confusion or incoherence can also be a potential sign of this deficiency.
In terms of physical examination, the symptoms vary based on the type of beriberi (a disease caused by thiamine deficiency) that an individual is afflicted with. Dry beriberi mainly results in nerve damage that includes:
- Signs of symmetric peripheral neuropathy with motor and sensory changes
- Weakened reflexes
In contrast, Wet beriberi affects heart functions due to disrupted energy metabolism leading to symptoms like:
- Dilated cardiomyopathy
- Rapid heartbeat
- High-output congestive heart failure
- Swelling in the extremities
It’s important to note that both wet and dry beriberi can have overlapping features, with tingling sensations potentially being a common indicator for both. Furthermore, Wernicke’s encephalopathy, a serious condition caused by thiamine deficiency, presents itself as a combination of eye abnormalities, confusion, and difficulties with coordination.
If this condition progresses to involve additional symptoms such as memory loss and delusions, it is consistent with Wernicke-Korsakoff syndrome.
Testing for Vitamin B1 (Thiamine) Deficiency
To identify a shortage of thiamine (vitamin B1) in the body, doctors often rely on a patient’s medical history and physical examination results. They then confirm the deficiency using various lab tests.
Lab Tests:
1. One such test involves assessing the activity of an enzyme called transketolase, which is necessary for the proper functioning of our bodies and needs thiamine to work. In this test, medical professionals measure how much the activity of transketolase increases when it’s given extra thiamine. If the enzyme becomes more than 25% more active, it could indicate that the body lacks sufficient thiamine.
2. Another method is to measure thiamine directly or its derivatives in blood or serum samples with a technique called high-performance liquid chromatography.
3. Tests can also be done using urine, but these aren’t as reliable for assessing thiamine levels in the whole body.
4. When the body doesn’t have enough thiamine, it can develop a condition known as metabolic acidosis, where the body produces too much acid (specifically, lactic acid). So doctors might check for this too.
Depending on the patient’s symptoms and other health conditions, doctors may recommend additional assessments. For example, if a patient exhibits new symptoms of heart failure, additional tests like an echo of the heart or a thyroid-stimulating hormone (TSH) measurement could be considered.
Radiographic Tests:
During a magnetic resonance imaging (MRI) scan, doctors often observe specific changes in the brain in patients deficient in thiamine, particularly those with a severe neurological condition called Wernicke’s encephalopathy (WE). These changes usually occur in brain areas such as the thalamus, mamillary bodies, periaqueductal area, and tectal plate.
Treatment Options for Vitamin B1 (Thiamine) Deficiency
Acute thiamine (vitamin B1) deficiency with cardiovascular or neurological signs and symptoms can be treated with 200mg of thiamine, either intravenously (through the vein) or orally (taking by mouth), three times daily. This should continue until the symptoms go away or no longer improve. After this point, the patient should switch to daily oral thiamine dose of 10mg until their recovery is complete.
Alternatively, during an acute health crisis, 50mg of thiamine can be administered via an injection in the muscle for 2-4 days, followed by regular oral therapy.
When it comes to treating thiamine deficiency in patients suspected of having Wernicke-Korsakoff syndrome, the course of treatment is a bit different. The first two days of therapy involve three doses of 500mg of intravenous thiamine, each infused over 30 minutes. From day three through to day five of therapy, the treatment shifts to 250mg of thiamine, given either intravenously or as an injection in the muscle.
It’s very important to give thiamine during the period of refeeding in alcoholism patients, to avoid an acute thiamine deficiency, which can lead to an unhealthy buildup of lactic acid in the body.
Please note that symptoms of Wernicke-Korsakoff syndrome might keep going for several months, or they might be permanent. However, other symptoms of thiamine deficiency like loss of appetite and irritability should gradually get better.
What else can Vitamin B1 (Thiamine) Deficiency be?
When trying to diagnose a thiamine deficiency, which is a shortage of vitamin B1 in the body, doctors have to consider many other conditions because the initial symptoms are quite vague and numerous. Furthermore, thiamine deficiency can cause a wide range of heart and nerve issues that can also be caused by other conditions.
They might need to check for the following conditions that can have similar symptoms:
- Delirium (a confused mental state)
- Depression
- Folic acid deficiency
- Hyperthyroidism (overactive thyroid)
- Heart muscle disease caused by other factors like alcoholism or diabetes
- Delusional disorder (strong belief in something despite clear evidence otherwise)
- Entrapment of nerves that can cause pain, numbness, or tingling
- Other mental health conditions
- Diabetic ketoacidosis (a dangerous condition caused by high levels of acids in the blood)
Investigators will carry out relevant investigations based on the above possible diagnoses to figure out what’s really going on.
What to expect with Vitamin B1 (Thiamine) Deficiency
Generally, patients with a deficit of thiamine (also known as Vitamin B1) have a good outlook since it’s easily treatable, and the signs and symptoms usually go away completely after taking thiamine supplements. If a patient has wet beriberi — a condition associated with this deficiency that affects the cardiovascular system — improvements can be seen within the first 24 hours of treatment.
When it comes to dry beriberi, which primarily affects the nervous system, symptoms may also improve or even completely go away with sufficient supplementation. However, if the deficiency has advanced to Korsakoff syndrome, a severe brain disorder, the patient may see only limited improvement during the initial treatment and any remaining symptoms could be permanent.
Possible Complications When Diagnosed with Vitamin B1 (Thiamine) Deficiency
Thiamine repletion, or replenishment, hasn’t been shown to cause any health risks. Though, in some cases, high doses of thiamine given through an IV reportedly caused potentially life-threatening allergic reactions and muscle spasms in the lungs.
Preventing Vitamin B1 (Thiamine) Deficiency
Education is crucial for patients dealing with alcohol misuse disorders. This education should include information about Korsakoff syndrome, a condition that can develop because excessive drinking can lead to a deficiency of a nutrient called thiamine. This educational approach should be coupled with a treatment program for substance misuse. The overall goal is to optimize patients’ chances of recovery, so this education needs to be part of a comprehensive approach involving a team of healthcare professionals.
Other causes of beriberi, a disease caused by thiamine deficiency, should also be addressed based on what’s causing the problem in the first place. Once that cause is tackled, patients need to commit to a suitable diet that includes enough thiamine. Fixing the diet can play a significant role in treating thiamine deficiency.
