Signs and Symptoms of Thiamine (Vitamin B1) Deficiency

Recommended Intakes of Vitamin B1 / Thiamine
Deficiency Symptoms of Vitamin B1 / Thiamine
Food Source of Vitamin B1 / Thiamine
Uses & Health Benefit of Vitamin B1 / Thiamine

Signs and Symptoms of Thiamine (Vitamin B1) Deficiency/Thiamine is a vitamin found in food and manufactured as a dietary supplement and medication. Food sources of thiamine include whole grains, legumes, and some meats and fish. Grain processing removes much of the thiamine content, so in many countries, cereals and flours are enriched with thiamine. Supplements and medications are available to treat and prevent thiamine deficiency and disorders that result from it, including beriberi and Wernicke encephalopathy. Other uses include the treatment of maple syrup urine disease and Leigh syndrome. They are typically taken by mouth, but may also be given by intravenous or intramuscular injection.

Thiamine also is known as thiamin or vitamin B₁, is a vitamin found in food, and manufactured as a dietary supplement and medication.^[rx]^[rx]Food sources of thiamine include whole grains, legumes, and some meats and fish.^[rx] Grain processing removes much of the thiamine content, so in many countries, cereals and flours are enriched with thiamine.^[rx]^[rx] Supplements and medications are available to treat and prevent thiamine deficiency and disorders that result from it, including beriberi and Wernicke encephalopathy.^[rx] Other uses include the treatment of maple syrup urine disease and Leigh syndrome.^[rx] They are typically taken by mouth, but may also be given by intravenous or intramuscular injection.^[rx]^[rx]

Recommended Intakes of Vitamin B1 / Thiamine

Intake recommendations for thiamin and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies (formerly National Academy of Sciences). DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and sex, include:

Recommended Dietary Allowance (RDA) – Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
Adequate Intake (AI) – Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
Estimated Average Requirement (EAR) – Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
Tolerable Upper Intake Level (UL) – Maximum daily intake unlikely to cause adverse health effects.

Table 1 lists the current RDA for thiamin. For infants from birth to 12 months, the FNB established an AI for thiamin that is equivalent to the mean intake of thiamin in healthy, breastfed infants.

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**Recommended Dietary Allowances (RDAs) for Thiamin**
Age	Male	Female	Pregnancy	Lactation
Birth to 6 months*	0.2 mg	0.2 mg
7–12 months*	0.3 mg	0.3 mg
1–3 years	0.5 mg	0.5 mg
4–8 years	0.6 mg	0.6 mg
9–13 years	0.9 mg	0.9 mg
14–18 years	1.2 mg	1.0 mg	1.4 mg	1.4 mg
19-50 years	1.2 mg	1.1 mg	1.4 mg	1.4 mg
51+ years	1.2 mg	1.1 mg

*AI

Age group	RDA (mg/day)	Tolerable upper intake level
United States
Infants 0–6 months	0.2*	ND
Infants 6–12 months	0.3*
1–3 years	0.5
4–8 years	0.6
9–13 years	0.9
Females 14–18 years	1.0
Males 14+ years	1.2
Females 19+ years	1.1
Pregnant/lactating females 14–50	1.4
* Adequate intake for infants, as an RDA has yet to be established
European Food Safety Authority
Age group	Adequate Intake (mg/MJ)	Tolerable upper limit
All persons 7 months+	0.1	ND

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Deficiency Symptoms of Vitamin B1 / Thiamine

Beriberi

Symptoms of beriberi include weight loss, emotional disturbances, impaired sensory perception, weakness and pain in the limbs, and periods of irregular heart rate. Edema (swelling of bodily tissues) is common. It may increase the amount of lactic acid and pyruvic acid within the blood. In advanced cases, the disease may cause high-output cardiac failure and death.

Symptoms may occur concurrently with those of Wernicke’s encephalopathy, a primarily neurological thiamine-deficiency related condition.

Beriberi is divided into four categories as follows. The first three are historical and the fourth, gastrointestinal beriberi, was recognized in 2004:

Dry beriberi – especially affects the peripheral nervous system.
Wet beriberi – especially affects the cardiovascular system and other bodily systems.
Infantile beriberi – affects the babies of malnourished mothers.
Gastrointestinal beriberi – affects the digestive system and other bodily systems.

Dry beriberi

Dry beriberi causes wasting and partial paralysis resulting from damaged peripheral nerves. It is also referred to as endemic neuritis. It is characterized by:

Difficulty in walking
Tingling or loss of sensation (numbness) in hands and feet
Loss of tendon reflexes
Loss of muscle function or paralysis of the lower legs
Mental confusion/speech difficulties
Pain
Involuntary eye movements (nystagmus)
Vomiting

A selective impairment of the large proprioceptive sensory fibers without motor impairment can occur and present as prominent sensory ataxia, which is a loss of balance and coordination due to loss of the proprioceptive inputs from the periphery and loss of position sense.

Brain disease

Wernicke’s encephalopathy is the most frequently encountered manifestation of thiamine deficiency in Western society, though it may also occur in patients with impaired nutrition from other causes, such as gastrointestinal disease, those with HIV/AIDS, and with the injudicious administration of parenteral glucose or hyperalimentation without adequate B-vitamin supplementation. This is a striking neuro-psychiatric disorder characterized by paralysis of eye movements, abnormal stance and gait, and markedly deranged mental function.

Korsakoff’s syndrome is, in general, considered to occur with the deterioration of brain function in patients initially diagnosed with WE. This is an amnestic-confabulatory syndrome characterized by retrograde and anterograde amnesia, impairment of conceptual functions, and decreased spontaneity and initiative.

Alcoholics may have thiamine deficiency because of the following:

Inadequate nutritional intake – Alcoholics tend to intake less than the recommended amount of thiamine.
Decreased uptake of thiamine from the GI tract – Active transport of thiamine into enterocytes is disturbed during acute alcohol exposure.
Liver thiamine stores – are reduced due to hepatic steatosis or fibrosis.
Impaired thiamine utilization – Magnesium, which is required for the binding of thiamine to thiamine-using enzymes within the cell, is also deficient due to chronic alcohol consumption. The inefficient utilization of any thiamine that does reach the cells will further exacerbate the thiamine deficiency.
Ethanol per se inhibits thiamine – transport in the gastrointestinal system and blocks phosphorylation of thiamine to its cofactor form (ThDP).

Following improved nutrition and the removal of alcohol consumption, some impairments linked with thiamine deficiency are reversed, in particular poor brain functionality, although in more severe cases, Wernicke–Korsakoff syndrome leaves permanent damage.

Wet beriberi

Wet beriberi affects the heart and circulatory system. It is sometimes fatal, as it causes a combination of heart failure and weakening of the capillary walls, which causes the peripheral tissues to become edematous. Wet beriberi is characterized by:

Increased heart rate
Vasodilation leading to decreased systemic vascular resistance, and high output heart failure
Elevated jugular venous pressure
Dyspnea (shortness of breath) on exertion
Paroxysmal nocturnal dyspnea
Peripheral edema (swelling of lower legs)
Dilated cardiomyopathy

Gastrointestinal beriberi

Gastrointestinal beriberi causes abdominal pain. Gastrointestinal beriberi is characterized by:

Abdominal pain
Nausea
Vomiting
Lactic acidosis

Infants

Infantile beriberi usually occurs between two and six months of age in children whose mothers have inadequate thiamine intake. It may present as either wet or dry beriberi.

In the acute form, the baby develops dyspnea and cyanosis and soon dies of heart failure. These symptoms may be described in infantile beriberi:

Hoarseness, where the child makes moves to moan but emits no sound or just faint moans caused by nerve paralysis
Weight loss, becoming thinner and then marasmic as the disease progresses
Vomiting
Diarrhea
Pale skin
Edema
Ill temper
Alterations of the cardiovascular system, especially tachycardia (rapid heart rate)
Convulsions occasionally observed in the terminal stages

Food Source of Vitamin B1 / Thiamine

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**Selected Food Sources of Thiamin**
Food	Milligrams (mg) per serving	Percent DV*
Breakfast cereals, fortified with 100% of the DV for thiamin, 1 serving	1.5	100
Rice, white, long grain, enriched, parboiled, ½ cup	1.4	73
Egg noodles, enriched, cooked, 1 cup	0.5	33
Pork chop, bone-in, broiled, 3 ounces	0.4	27
Trout, cooked, dry heat, 3 ounces	0.4	27
Black beans, boiled, ½ cup	0.4	27
English muffin, plain, enriched, 1 muffin	0.3	20
Mussels, blue, cooked, moist heat, 3 ounces	0.3	20
Tuna, Bluefin, cooked, dry heat, 3 ounces	0.2	13
Macaroni, whole wheat, cooked, 1 cup	0.2	13
Acorn squash, cubed, baked, ½ cup	0.2	13
Rice, brown, long grain, not enriched, cooked, ½ cup	0.1	7
Bread, whole wheat, 1 slice	0.1	7
Orange juice, prepared from concentrate, 1 cup	0.1	7
Sunflower seeds, toasted, 1 ounce	0.1	7
Beef steak, bottom round, trimmed of fat, braised, 3 ounces	0.1	7
Yogurt, plain, low fat, 1 cup	0.1	7
Oatmeal, regular and quick, unenriched, cooked with water, ½ cup	0.1	7
Corn, yellow, boiled, 1 medium ear	0.1	7
Milk, 2%, 1 cup	0.1	7
Barley, pearled, cooked, 1 cup	0.1	7
Cheddar cheese, 1½ ounces	0	0
Chicken, meat and skin, roasted, 3 ounces	0	0
Apple, sliced, 1 cup	0	0

*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for thiamin is 1.5 mg for adults and children age 4 and older. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

The U.S. Department of Agriculture’s (USDA’s) Nutrient Database website lists the nutrient content of many foods and provides a comprehensive list of foods containing thiamin arranged by nutrient content and by food name.

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Uses & Health Benefit of Vitamin B1 / Thiamine

Effective for

Metabolic disorders – Taking thiamine by mouth helps correct metabolic disorders associated with genetic diseases, including Leigh’s disease, maple syrup urine disease, and others.
Thiamine deficiency – Taking thiamine by mouth helps prevent and treat thiamine deficiency.
Brain disorder due to thiamine deficiency (Wernicke-Korsakoff syndrome) – Thiamine helps decrease the risk and symptoms of a specific brain disorder called Wernicke-Korsakoff syndrome (WKS). This brain disorder is related to low levels of thiamine (thiamine deficiency) and is often seen in alcoholics. Between 30% and 80% of alcoholics are believed to have thiamine deficiency. Giving thiamine shots seems to help decrease the risk of developing WKS and decrease symptoms of WKS during alcohol withdrawal.
Cataracts – High thiamine intake as part of the diet is associated with a reduced risk of developing cataracts.
Kidney disease in people with diabetes – Early research shows that taking high-dose thiamine (100 mg three times daily) for 3 months decreases the amount of albumin in the urine in people with type 2 diabetes. Albumin in the urine is an indication of kidney damage.
Painful menstruation (dysmenorrhea) – Early research suggests that taking thiamine for 90 days stops pain associated with menstruation in girls 12-21 years-old.
Repelling mosquitos. Some research shows that taking B vitamins, including thiamine, does not help repel mosquitos.

Insufficient Evidence for

Athletic performance – Some research suggests that taking thiamine together with pantethine and pantothenic acid (vitamin B5) does not improve muscle strength or endurance in athletes.
Preventing cervical cancer – Some research suggests that increasing intake of thiamine from dietary and supplement sources, along with another folic acid, riboflavin, and vitamin B12, might decrease the risk of precancerous spots on the cervix.
Poor appetite.
Ulcerative colitis.
Chronic diarrhea.
Stomach problems.
Brain conditions.
AIDS.
Heart disease.
Alcoholism.
Stress.
Aging.
Canker sores
Other conditions

References