August 30, 2018
Alcohol related thiamine deficiency
Thiamine, also known as vitamin B1, has a number of essential functions within the body. It is an important nutrient for taking energy from food and turning it into energy for the brain, nerves and heart. Thiamine is needed by the body to process fats and proteins – but it is most important for processing carbohydrates (sugars and starches).1
Thiamine is naturally present in some foods, including:
- whole grain products such as cereals, rice, pasta, and flour
- wheat germ
- beef and pork
- trout and bluefin tuna
- legumes and peas
- nuts and seeds.2
It is also added to some food products such as bread3 and is available as a dietary supplement.
While fruit, vegetables, and dairy products are not very high in thiamine, they can become a substantial source of thiamine when eaten in large amounts.2
Thiamine deficiency is common in drinkers who consume excessive amounts of alcohol. This is due to:
- poor nutrition and the diet not containing enough essential vitamins, and
- inflammation of the stomach lining due to excessive alcohol consumption, which reduces the body’s ability to absorb vitamins.4
Thiamine deficiency can cause:
- loss of appetite
- fatigue and muscle weakness.
If a lack of thiamine persists, a condition called beriberi may develop over the following weeks or months.5 There are two types of beriberi - wet beriberi and dry beriberi. Wet beriberi affects the heart and circulatory system and in extreme cases can cause heart failure. Dry beriberi damages the nerves and can lead to decreased muscle strength and eventually, muscle paralysis. If untreated beriberi can be life-threatening.5
In extreme cases, beriberi is associated with Wernicke-Korsakoff syndrome. Wernicke encephalopathy and Korsakoff syndrome are two forms of brain damage caused by thiamine deficiency. Both are conditions due to brain damage which is often caused by excessive alcohol use.4
Wernicke’s encephalopathy is a form of serious brain injury resulting from a lack of thiamine that most commonly occurs in alcohol-dependent people. It is not a withdrawal complication, but it is often identified in people undergoing alcohol withdrawal. It can co-exist with and should be distinguished from acute alcohol withdrawal, loss of brain function due to liver disease, and other causes of confusion.6
Wernicke’s encephalopathy is usually reversible, but if untreated or inadequately treated can lead to Korsakoff’s syndrome, a chronic and disabling condition characterised by severe short-term memory loss and impaired ability to acquire new information. It is important to remember that Korsakoff’s syndrome is not dementia or delirium.6
Symptoms of Wernicke-Korsakoff’s syndrome include:
- mental confusion
- paralysis of the nerves that move the eyes
- an impaired ability to coordinate movements particularly of the lower extremities.
If you are concerned about vitamin depletion as a result of drinking alcohol, talk to your health professional.
- Whittington Health. About Thiamine (B1) and Thiamine Deficiency. London: North London Obesity Surgery Service Available from: https://www.whittington.nhs.uk/document.ashx?id=1957.
- Medline Plus. Thiamin. Bethesda: U.S. National Library of Medicine; 2019 Available from: https://medlineplus.gov/ency/article/002401.htm.
- Food Standards Australia & New Zealand. Thiamin levels in Australian breads: Results from the 2010 and 2012 national bread surveys Food Standards Australia New Zealand; 2016 Available from: http://www.foodstandards.gov.au/publications/Pages/Thiamin-in-bread.aspx.
- 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.
- Upfal J. Australian drug guide : the plain language guide to drugs and medicines of all kinds. Melbourne, Vic.: Black Inc.; 2016.
- Drug and Alcohol Services South Australia (DASSA). Management of patients at risk of alcohol withdrawal in acute hospitals. Government of South Australia; 2016.