Thiamine (Vitamin B1) plays an essential role in converting food into energy and also affects how your metabolism works. Chronic alcohol consumption (i.e. alcoholism) can lead to thiamine deficiency which can carry severe physical consequences if left untreated.
Did you know that an estimated 30% to 80% of all alcoholics suffer from some degree of thiamine deficiency? And, did you know that thiamine deficiency is the leading cause of the alcohol-related brain disorder Wernicke-Korsakoff syndrome (WKS)?
In this article, Rehab Guide explains why avoiding vitamin deficiency is crucial for maintaining brain health and physical health if you are a problem drinker. We also describe the symptoms of thiamine deficiency, why alcoholics are prone to suffering from it, and – if you are a heavy drinker, what you can do to safeguard yourself from developing it.
What is Thiamine/ B1?
Thiamine, part of the B complex family of vitamins, also known as thiamin or vitamin B1 is an essential vitamin found in food and in manufactured dietary supplement medications.
Thiamine is not a vitamin that the body produces enough of, but is a vitamin that the body needs in order to function correctly.
Thiamine was the first B vitamin to be discovered by scientists; hence it is called vitamin B1. Vitamin B1 is one of the eight essential B vitamins that assist in converting food into energy and is necessary for the healthy function of the central and peripheral nervous system (1)
Thiamine (vitamin B1) can be found in many food sources, including whole grains and some meats and fish. Vitamin B1 deficiency generally affects those with a poor and unbalanced diet. It also affects those that suffer from conditions that prevent them from absorbing the nutrient through the food they eat.
Being deficient in thiamin for a lengthy period of time can cause severe health consequences to the nervous system, heart, and the brain. In the most severe cases it can prove fatal (2)
The role of vitamin B1/ Thiamine in the body
Thiamin is also needed by the body to break down and process fats and proteins and turn them into energy. It is also vital for processing carbohydrates, sugars and starches.
The vitamins acquired from our diet supplies our vital organs and nervous system with essential energy in order to function efficiently and stay healthy (3)
Who is at risk of thiamine deficiency
Thiamine deficiency is far less common today than it was back in the undeveloped world. We are fortunate to have many food sources, and most people are able to eat a reasonably balanced diet.
Thiamine deficiency does, however, affect individuals that suffer from certain medical conditions. Medical conditions that impair thiamin levels and can lead to vitamin B1 deficiency include:
- Alcoholism/alcohol addiction and alcohol dependency
- Crohn’s disease
- Anorexia (a life-threatening eating disorder)
- Conditions such as heart failure that require long term diuretic treatment (4)
Alcohol-related thiamine deficiency – What causes it?
Alcohol-related thiamine deficiency in excessive drinkers is due to two main causes:
- Alcoholics are more prone to having a reduced nutritional intake and consume a diet that is lacking in essential vitamins
- Excessive alcohol consumption causes inflammation of the stomach lining and gastrointestinal tract; this affects the body’s ability to absorb vitamins through the stomach’s lining (5)
Preventing and treating thiamine deficiency if you are alcoholic
It is medically recommended that those who suffer from alcohol addiction/alcohol dependency or drink excessively, ensure that they take strong thiamine B1 supplements. Thiamine tablets may not be suitable for some people, so always ensure you ask for medical advice and that they are prescribed by your GP.
What is thiamine used for? Vitamin B1 (thiamine) tablets necessary for:
- Healthy nerve function
- Cardiovascular health
- Energy production
If your doctor diagnoses you as thiamine deficient already, they can arrange for you to have vitamin B1 injections (thiamine hydrochloride)—this way the vitamin is absorbed directly into the bloodstream, bypassing the stomach lining.
If you are able to eat a balanced diet, foods that are rich in thiamin vitamin B1 include:
- Whole-grain foods such as cereals, flour, pasta and rice
- Wheat germ
- Meats – pork and beef (in particular steak)
- Fish – trout, bluefin tuna fish and seafood such as muscles
- Nuts and seeds (6)
The best method to retain as many of the water-soluble vitamins as possible is to steam or grill meals.
Even if you are able to consume a diet rich in thiamin, it is still recommended that you take supplements if you are a heavy drinker. Your stomach lining may be affected by the alcohol to such an extent that you are unable to properly absorb essential vitamins and nutrients.
Please do not try to self manage this by buying your own supplements. It is essential that you see your GP if you are worried you may be thiamine deficient.
Signs and symptoms of Thiamine/B1 deficiency
Alcohol-related thiamine deficiency symptoms can range from mild to severe. If you are a heavy drinker and experience ANY of the following symptoms, please see your doctor without delay:
- Weight loss
- Loss of appetite
- Chronic fatigue
- Weakness in legs
- Tingling sensation in arms and hands (pins and needles)
- Poor concentration levels
- Heart palpitations
- Water retention (oedema)
- Irritability and a general feeling of unwellness and low in mood (7)
Thiamine side effects
Any thiamine/vitamin B1 that is surplus to requirements is dispelled by the body through urine. Thiamine has no known toxicity levels. However, those with kidney disease should only take thiamine therapy under doctor’s instructions.
It is possible to be allergic to thiamine B1, and it may interact with other medicines you are taking. It is essential that your doctor is aware of all medications and drugs that you are taking and if you have ever previously experienced an allergic reaction to thiamine B1.
If you are taking prescribed thiamine B1 and experience any of the symptoms of an allergic reaction, please contact your doctor if symptoms are severe call your local emergency services immediately.
Symptoms of thiamine B1 allergy include:
Mild symptoms of thiamine allergy – call your doctor
- Itching or a mild rash
- Tightness in throat
- Feeling restless
- Tenderness and a hard lump at the injection site (8)
Severe symptoms of thiamine B1 allergy – emergency services required
- Chest pain and shortness of breath
- Cough up or vomiting blood
- Black, bloody or tarry stools
- Bluish tinge to lips (8)
Risks associated with thiamine deficiency to the heart and nerves
Thiamine deficiency is common in alcoholics due to inadequate nutritional intake and reduced absorption levels. Being severely thiamin deficient, or a deficiency in thiamine B1 for a prolonged period of time carries very real risks to a person’s health. In particular, thiamine deficiency can interfere with the healthy function of the heart, circulatory system, nervous system and the brain.
In more severe cases of alcoholism, alcohol-related brain damage can occur. This damage can be irreversible and varies in severity. Thiamine deficiency due to poor diet is now eradicated from most countries in the world; however, the consequences common in chronic alcohol consumers can sometimes lead to beriberi. This causes mainly peripheral neuropathy and cardiovascular disease, affecting peripheral nerves, but the most important outcome is serious Wernicke Korsakoff Syndrome.
There are two types of this heart-related condition – wet Beriberi and dry Beriberi. (9)
Dry beriberi can also develop from alcohol-induced thiamine deficiency and causes damages to the nerves. This can lead to muscle weakness and (if left untreated), eventually paralysis. In severe cases of dry beriberi, the sufferer can also die (9)
Wernicke’s encephalopathy can cause:
- Paralysis of eye muscles,
- Unnatural walking, confusion
- Korsakoff’ psychosis
- Severe impairment of particularly short-term memory
Alcohol-induced thiamine deficiency and the brain – Wernicke’ s-Korsakoff’s syndrome
Chronic alcoholism that results in severe and prologued thiamine/B1 deficiency can cause the brain to become severely damaged.
Wernicke’s encephalopathy and Korsakoff dementia are two forms of brain damage caused by alcohol-related thiamin deficiency.
Wernicke’s encephalopathy commonly occurs in long term alcohol-dependent drinkers. It is a type of brain injury-related that results from thiamin deficiency over a prolonged period of time.
Wernicke’s encephalopathy can be reversed if promptly and correctly medically treated. However, if it is left untreated, it can lead to Korsakoff’s syndrome.
Korsakoff’s syndrome is a chronic and disabling condition that cannot be reversed. It has symptoms similar to dementia. Again, this condition commonly occurs in the long term alcohol-dependent drinkers suffering from thiamin deficiency (3,5)
Symptoms of Wernicke-Korsakoff’s syndrome include:
- mental confusion
- paralysis of the nerves that affect the eyes
- a damaged ability to correlate movements particularly in the hands and legs
- Inability to retain knowledge or form new memories
- Severe short term memory loss (3,5)
Those that suffer from Wernicke-Korsakoff’s syndrome usually require full-time care within a medical institution or care home.
Why thiamine is used during a medical alcohol detox
During a medical alcohol detox conducted within one of our CQC registered rehabs, as well as receiving medication to suppress and control alcohol withdrawal symptoms, you will also be prescribed daily thiamin and strong vitamin B1. This will be administered either orally or by injection, depending on your state of health.
True recovery from addiction could be described as abstinence without cravings and engagement in productive activities. Factors that improve retention, treatment completion, and increase time in treatment lead to better outcomes. These include factors that decrease withdrawal symptoms and cravings. Improved nutritional status can make treatment more effective while reducing alcohol craving, thereby preventing relapse. Thiamine supplements help to protect the brain during the detox process and help to replenish where you are deficient.
In addition to prescribed medication, our detox clinics and rehab centres strongly believe in providing our patients with delicious but also nutritionally balanced meals.
Our qualified chefs will take into account any dietary requirements you may have and ensure that you receive wholesome and freshly prepared meals each day. This will speed up the healing process and ensure you are getting the correct amount of nutrients to support your recovery.
For more information on our inpatient alcohol detoxes and how we can help you or a family member to stop drinking safely, call and speak with our experts for a free and confidential alcohol assessment on 0207 2052845
- What does Vitamin B1 do? https://www.healthline.com/health/vitamin-watch-b1-thiamine
- Mahan LK, Escott-Stump S, eds. (2000). Krause’s food, nutrition, & diet therapy (10th ed.). Philadelphia: W.B. Saunders Company.
- The Role of Thiamine Deficiency in Alcoholic Brain Disease Alcohol Research & Health. 2003;27(2): 134-42 Peter R. Martin, M.D., Charles K. Singleton, Ph.D., and Susanne Hiller–Sturmhöfel, Ph.D.
- Katta N, Balla S, Alpert MA (July 2016). “Does Long-Term Furosemide Therapy Cause Thiamine Deficiency in Patients with Heart Failure? A Focused Review”. The American Journal of Medicine.
- Dementia Australia. Alcohol related dementia and Wernicke-Korsakoff syndrome: Dementia Australia; 2016 Available from: https://www.dementia.org.au/files/helpsheets/Helpsheet-AboutDementia18-AlcoholRelatedDementiaAndWernickeKorsakoffSyndrome_english.pdf.
- Medline Plus. Thiamin. Bethesda: U.S. National Library of Medicine; 2019 Available from: https://medlineplus.gov/ency/article/002401.htm.
- International Nomenclature of Diseases. Vol. IV Metabolic, Nutritional, and Endocrine Disorders. WHO, Geneva 1991 pg 277.
- Upfal J. Australian drug guide : the plain language guide to drugs and medicines of all kinds. Melbourne, Vic.: Black Inc.; 2016.