Do You Have a Thiamine Deficiency?

Thiamine Deficiency

Carbohydrate Metabolism

Thiamine (a.k.a vitamin B1) is a molecule required for the production of critical enzymes regulating carbohydrate metabolism and the general production of energy in the form of ATP (Adenosine Triphosphate, your body's main energy source!). In other words, reactions that break down carbohydrates for energy aren't going to work properly. It goes without saying that a diet deficient in thiamine will result in decreased energy since the individual will not produce ATP adequately.

Nervous System Function

This deficiency specifically affects the nervous system from the brain to peripheral nerves. The most important function of thiamine in the nervous system (aside from providing energy for normal processes) is the production of acetylcholine, a neurotransmitter that transmits electrical signals between nerve endings. A lack of acetylcholine will subsequently result in a large increase in dopamine, causing hallucinations (referred to as Korsakoff's psychosis, see below).

Thiamine is involved in both carbohydrate metabolism and synthesizing acetylcholine because both processes involve the same enzyme, called pyruvate dehydrogenase (PDH). Knocking just one enzyme out can cause a full spectrum of problems!

Appetite and Digestion

The digestive system contains the largest plexus of innervating nerves in the body aside from the brain. These nerves control appetite signaling (i.e. secretion of stomach acid, a hormone called gastrin and histamine), digestion, absorption of nutrients and movement of waste products through the intestine.

Upsetting this complex of nerves compromises their function, leading to problems involving hormonal and nervous signals that will debilitate your ability to perform proper digestion!

Infants

Newborn infants get their thiamine from breast milk. Therefore, if the mother is deficient, then it stands to reason that the baby will also develop a thiamine deficiency.

Clinical Diagnosis of a Thiamine Deficiency

Thiamine is required for proper functioning of an enzyme called transketolase. Basically, it converts "other" sugars (like ribose and xylulose) from the diet into usable sugars like fructose and glucose. These usable sugars then enter glycolysis for energy production (this series of reactions is called the Hexose Monophosphate Pathway).

When there's a thiamine deficiency, the concentration of transketolase in the red blood cells is extremely low, resulting in the symptoms listed in the table above (namely fatigue and apathy).

Because transketolase concentrations are different in every individual (depending on their metabolic rate), we can't just measure the concentration to determine whether or not a vitamin B1 deficiency is present.

Instead, doctors actually give thiamine and observe how the concentration of transketolase changes. If it's concentration increases significantly with the extra thiamine, a thiamine deficiency is diagnosed. After the thiamine is given, the individual will ravenously produce transketolase for survival, thereby increasing the concentration in red blood cells.

Beriberi

Beriberi is characterized by a severe thiamine deficiency, usually in alcoholics in the U.S. and in other locations where white rice is a significant part of the diet (as in many Asian countries). Symptoms include....

Weight Loss (not the good kind, of course)

Weakness/Fatigue (especially in the arms and legs)

Arrhythmia (irregular heart beat)

Increased Lactic Acid (and pain in the limbs)

Severe cases can cause death

These individuals are usually treated with thiamine hydrochloride, replenishing their system of the vitamin. Dramatic improvements can be seen very quickly!

Wernicke-Korsakoff Syndrome

This one is more apparent in the U.S. because of the prominence of alcoholism. This occurs because alcohol becomes a major proportion of the individual's diet. It's basically a continuance of beriberi. It's normally caused by dietary insufficiency and/or impaired absorption of vitamin B1. Some of the symptoms include...

Odd Movements of the Eyes (a.k.a. nystagmus)

Memory Loss (Wernicke's Encephalopathy)

Hallucinations (Korsakoff Psychosis)

Anxiety

Depression

Loss of Appetite

Muscle Wasting

Seizures (a.k.a. Delerium Tremens, due to alcohol withdrawal)

Treatment of the syndrome usually consists of a thiamine supplement (intravenously) before glucose intake. Taking the glucose before thiamine worsens the condition since glucose depletes thiamine!

Since the most common cause of thiamine deficiency in the U.S. is alcoholism, most patients arriving to emergency rooms with s eizures are automatically placed on a thiamine supplement!! Alcohol withdrawal causes seizures (Delirium Tremens) which can be treated with IV thiamine supplements, a short-acting benzodiazepine (a drug that decreases the activity of the brain) and, if recurrent, an anti-epileptic drug such as phenytoin or phenobarbital.

That might be more than you might want to know, but there it is anyway :)

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