“Beriberi” may sound cute, but the consequences of this condition can be fatal. Advanced thiamine deficiency causes heart and nerve damage and increases the risk of various diseases. Read on to learn what signals deficiency early on and what you can do to prevent it.<\/p>\n
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Thiamine<\/a>, also known as vitamin B1, helps you break down food and deliver energy to each cell in your body. In the form of thiamine pyrophosphate (TPP), or thiamine diphosphate (TDP), vitamin B1 supports the enzymes that [R<\/a>, R<\/a>, R<\/a>, R<\/a>]:<\/p>\n Thiamine deficiency<\/b> can result from reduced intake, enhanced loss, or impaired metabolism of this essential nutrient.<\/p>\n The term \u201cberiberi\u201d was coined to describe malnourished people with severe thiamine deficiency and distinct symptoms of heart and nerve damage<\/b>. In developed countries, it\u2019s mostly limited to people with alcoholism<\/b> and other health disorders, which we\u2019ll discuss later in this post [R<\/a>, R<\/a>].<\/p>\n Normal thiamine blood levels depend on the lab method and literature source. Generally speaking, people with less than 66-70 nmol\/L of thiamine diphosphate<\/b> are potentially deficient [R<\/a>, R<\/a>].<\/p>\n However, blood thiamine has notable limitations as a diagnostic tool. Please see the \u201cDiagnosis<\/b>\u201d section for more details.<\/p>\n Some vulnerable groups have increased demand for thiamine and are at a higher risk of deficiency; they include:<\/p>\n Chronic alcohol abuse is the most common cause of thiamine deficiency in the United States and other developed countries. Alcoholism depletes thiamine levels by [R<\/a>, R<\/a>, R<\/a>]:<\/p>\n A lack of this vitamin can severely damage the nerves, and experts recommend extensive thiamine treatment for all people with a history of alcohol abuse [R<\/a>].<\/p>\n Unfortunately, thiamine deficiency is a serious issue for malnourished people in \u201cthird world\u201d countries. It\u2019s particularly common in poor Asian regions where polished rice and other processed grains<\/b> are staples of the diet, and people cannot afford vitamin-rich foods [R<\/a>, R<\/a>].<\/p>\n Bran contains most of the thiamine in rice; thus, milling and the removal of rice bran deplete vitamin B1, making people prone to deficiency if they don\u2019t or can\u2019t eat meat and legumes [R<\/a>].<\/p>\n Breastfed infants from deficient mothers<\/b> face similar dangers, often with severe impact on their development. Babies may also suffer from beriberi if they are fed inadequate milk-replacement formulas [R<\/a>, R<\/a>, R<\/a>].<\/p>\n People with eating disorders such as anorexia<\/b> lack an array of essential nutrients because they do not eat enough food. They may experience life-threatening nerve damage due to thiamine deficiency [R<\/a>, R<\/a>].<\/p>\n Food intake after prolonged starvation, known as refeeding syndrome<\/b>, drastically increases thiamine breakdown and may also trigger deficiency symptoms [R<\/a>, R<\/a>].<\/p>\n Prolonged diarrhea and vomiting<\/b> may cause excess vitamin B1 loss. Patients who experience confusion and vision impairment need immediate medical care and the supply of thiamine, fluid, and electrolytes [R<\/a>, R<\/a>].<\/p>\n For the same reason, severe vomiting during pregnancy<\/b> (hyperemesis gravidarum) may cause thiamine deficiency if left untreated [R<\/a>].<\/p>\n IBD<\/a> and other diseases with impaired bowel function can also prevent you from getting enough of this vitamin [R<\/a>, R<\/a>, R<\/a>].<\/p>\n Any surgery performed on the stomach or intestines can reduce thiamine absorption and make you prone to deficiency.<\/p>\n Thiamine deficiency is also a possible side effect of bariatric (<\/b>weight loss<\/b><\/a>) surgeries<\/b>, which change the size or structure of the stomach and small intestine. Experts suggest checking thiamine status before the surgery and supplementing in people at risk of deficiency [R<\/a>, R<\/a>, R<\/a>, R<\/a>].<\/p>\n Up to 30% of obese people seeking bariatric surgery already have low thiamine levels, which often go undiagnosed [R<\/a>, R<\/a>].<\/p>\n According to a study of 400 patients, higher BMI (body mass index) increases the risk of thiamine deficiency. This may be due to a diet high in refined sugar and fats and low in whole grains [R<\/a>, R<\/a>].<\/p>\n People who are unable to eat and digest food depend on a steady supply of parenteral (injected) nutrients. Despite decades of experience and advances in parenteral nutrition, some patients still get thiamine deficiency due to low vitamin B1 content<\/b> in the formulations [R<\/a>, R<\/a>, R<\/a>].<\/p>\n Prolonged glucose<\/a> infusions without added vitamin B1 can also drop thiamine levels and even cause nerve damage [R<\/a>, R<\/a>].<\/p>\n People who take diuretics (“water pills”) long-term produce larger amounts of urine, which flushes more thiamine from the body and raises the risk of deficiency.<\/p>\n Patients with heart failure<\/b> are especially vulnerable, as they receive large doses of furosemide (Lasix) and other potent diuretics [R<\/a>, R<\/a>].<\/p>\n In one clinical trial, high doses of furosemide (80 mg\/day) caused severe thiamine deficiency in 98%<\/b> of patients (24\/25). Besides increasing urination, this drug may also directly inhibit thiamine uptake into the cells that need it [R<\/a>, R<\/a>].<\/p>\n Vitamin B1 supports several enzymes involved in glucose metabolism. The function of these enzymes is often impaired in people with diabetes [R<\/a>].<\/p>\n In a study of 94 patients, blood thiamine was 76% lower in type 1 and 75% lower in type 2 diabetic people<\/b>, compared with healthy volunteers. Both diabetic groups also lost more thiamine in their urine [R<\/a>].<\/p>\n According to a study of 60 patients, kidney damage may cause thiamine loss in diabetics [R<\/a>].<\/p>\n Mutations in the following genes can impair thiamine transport into cells and increase the risk of deficiency [R<\/a>]:<\/p>\n An error can also occur due to mutations in one or more enzymes that transform thiamine into its active forms, such as thiamine pyrophosphokinase 1<\/i> (TPK1) [R<\/a>].<\/p>\n The following conditions can increase the risk of thiamine deficiency:<\/p>\n Magnesium<\/a> enables the conversion of thiamine into its active form, thiamine pyrophosphate (TPP), and they work together to produce energy. Magnesium deficiency may thus mimic thiamine deficiency and lessen the effects of supplementation [R<\/a>, R<\/a>, R<\/a>].<\/p>\n Therefore, if you suspect you are deficient in thiamine, make sure you get enough magnesium in your diet as well.<\/p>\n Initially, thiamine deficiency can produce general symptoms such as [R<\/a>, R<\/a>]:<\/p>\n Prolonged deficiency causes typical neurological beriberi symptoms<\/b>, including [R<\/a>, R<\/a>, R<\/a>]:<\/p>\n That said, beriberi is rare in the US and other developed countries. It occurs after months of severe deficiency, mostly due to alcohol abuse or health disorders described above<\/b> [R<\/a>].<\/p>\n Dry beriberi is a form with dominant nerve damage<\/b> and neurological symptoms described above. It can sometimes resemble Guillain-Barr\u00e9 syndrome<\/i> with ascending paralysis (progressing from the legs up), numbness, and low blood pressure [R<\/a>, R<\/a>].<\/p>\n Wet beriberi manifests with heart failure<\/b>, causing signs and symptoms such as [R<\/a>, R<\/a>]:<\/p>\n It can cause heart damage typical of certain respiratory conditions like cor pulmonale<\/i>, in which the right side of the heart is enlarged [R<\/a>, R<\/a>].<\/p>\n Shoshin beriberi<\/b> is a severe and rapid form of heart failure which often ends in death [R<\/a>, R<\/a>, R<\/a>].<\/p>\n Some symptoms, especially the burning and tingling sensations in the feet and legs, can appear in both wet and dry beriberi [R<\/a>].<\/p>\n In rare cases, thiamine deficiency can manifest with digestive symptoms such as nausea, vomiting, and stomach pain<\/b>. Scientists coined the term “gastrointestinal beriberi<\/i>” to describe such cases, which are more common among infants [R<\/a>, R<\/a>].<\/p>\n Severe cases in infants cause pale or purple skin, swelling, and eventually convulsions and heart failure [R<\/a>, R<\/a>, R<\/a>].<\/p>\n The lack of thiamine shifts your cells to anaerobic metabolism<\/b> (energy production without oxygen), which results in lactate<\/a> accumulation. Over a long period of time, this process can lead to a dangerous metabolic disorder called lactic acidosis [R<\/a>, R<\/a>].<\/p>\n Toxic amounts of lactate contribute to a range of beriberi symptoms, such as nerve damage and heart failure [R<\/a>].<\/p>\n Most patients with thiamine deficiency have elevated lactate in their blood and urine; this makes lactate a useful lab marker to confirm the diagnosis [R<\/a>, R<\/a>].<\/p>\n The brain is particularly sensitive to the lack of vitamin B1. Deficiency causes oxidative stress<\/a>, inflammation, lactic acidosis, and nerve damage. If energy production remains compromised and thiamine stays low, brain cells will die [R<\/a>, R<\/a>].<\/p>\n Wernicke’s encephalopathy<\/i> is a type of life-threatening brain damage<\/b> caused by thiamine deficiency. The most common symptoms include [R<\/a>, R<\/a>, R<\/a>]:<\/p>\n If left untreated, Wernicke\u2019s encephalopathy can progress into psychosis with memory loss, known as Korsakoff syndrome<\/i>. Once the disease progresses this far, brain injuries are permanent and often end in death [R<\/a>, R<\/a>].<\/p>\n Wernicke-Korsakoff syndrome<\/i>, also called wet brain<\/b>, is a transitional state between Wernicke\u2019s encephalopathy and Korsakoff syndrome, with mixed features of both [R<\/a>].<\/p>\n These conditions are most common in alcoholics, and they greatly contribute to alcohol-induced brain damage and delirium. However, Wernicke-Korsakoff syndrome can also develop in other cases of thiamine deficiency [R<\/a>].<\/p>\n Mild thiamine deficiency won\u2019t harm the organs instantly, but in the long run, it may increase the risk of various health disorders.<\/p>\n Thiamine is essential for glucose metabolism; deficiency can impair insulin secretion and contribute to diabetes [R<\/a>, R<\/a>].<\/p>\n In diabetes, toxic glucose levels damage the blood vessels. Thiamine deficiency intensifies the problem by causing inflammation and oxidative stress<\/b> [R<\/a>].<\/p>\n As a result, the lack of this vitamin can increase LDL<\/a> cholesterol, total cholesterol<\/a>, and triglycerides<\/a> while reducing beneficial HDL<\/a> cholesterol [R<\/a>, R<\/a>].<\/p>\n The lack of thiamine can also prevent insulin<\/a> secretion and worsen diabetes complications. Optimal thiamine intake may prevent major diabetes complications, including [R<\/a>, R<\/a>, R<\/a>]:<\/p>\n A meta-analysis of 9 clinical trials found that thiamine deficiency is 2.5 times<\/b> more common among patients with heart failure. They often lack this vitamin due to diuretic use, malnutrition, and alcoholism [R<\/a>, R<\/a>].<\/p>\n In some of these patients, thiamine deficiency may further impair heart function<\/b> and worsen their symptoms. A review of clinical and animal trials confirmed the role of thiamine deficiency in the development of heart disease [R<\/a>, R<\/a>].<\/p>\n Supplementation with this vitamin may boost heart function and improve other symptoms of heart failure in deficient patients, but the available research is limited [R<\/a>, R<\/a>].<\/p>\n Vitamin B1 enables the production of neurotransmitters such as glutamate<\/a>, acetylcholine<\/a>, and serotonin<\/a>. Flawed or reduced neurotransmitters can impact mental health and raise the risk of depression<\/a> [R<\/a>].<\/p>\n Oxidative stress and mitochondrial dysfunction induced by thiamine deficiency can harm the hippocampus, the brain\u2019s hub for memory and emotions [R<\/a>].<\/p>\n\n
Deficiency Criteria<\/b><\/span><\/h3>\n
People at Risk<\/b><\/span><\/h3>\n
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Causes<\/b><\/span><\/h2>\n
1) Alcoholism<\/b><\/span><\/h3>\n
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2) Poor Nutrition & Eating Disorders<\/b><\/span><\/h3>\n
Poor Nutrition<\/b><\/h4>\n
Eating Disorders<\/b><\/h4>\n
3) Digestive Disorders<\/b><\/span><\/h3>\n
4) Gut Surgery<\/b><\/span><\/h3>\n
5) Obesity<\/b><\/span><\/h3>\n
6) Parenteral Nutrition<\/b><\/span><\/h3>\n
7) Diuretics<\/b><\/span><\/h3>\n
8) Diabetes<\/b><\/span><\/h3>\n
9) Genetics<\/b><\/span><\/h3>\n
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10) Other<\/b><\/span><\/h3>\n
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Signs & Symptoms<\/b><\/span><\/h2>\n
1) General Symptoms<\/b><\/span><\/h3>\n
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2) Beriberi<\/b><\/span><\/h3>\n
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Dry Beriberi<\/b><\/h4>\n
Wet Beriberi<\/b><\/h4>\n
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3) Digestive Symptoms<\/b><\/span><\/h3>\n
4) Lactic Acidosis<\/b><\/span><\/h3>\n
5) Brain Damage<\/b><\/span><\/h3>\n
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Wernicke-Korsakoff Syndrome<\/b><\/h4>\n
Conditions Linked to Thiamine Deficiency<\/b><\/span><\/h2>\n
1) Diabetes<\/b><\/span><\/h3>\n
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2) Heart Disease<\/b><\/span><\/h3>\n
3) Mental Disorders<\/b><\/span><\/h3>\n