Thiamine deficiency isn’t limited to just Alcoholism

In the western world, dietary deficiency of Thiamine is traditionally thought to be rare since foods such as flour are enriched with thiamine. However the more I understand the vital importance of thiamine in our bodies, how poor our absorptive and storage capacity for thiamine is and how many things affect it’s uptake and disposal in our body, I more I am convinced that there indeed exists a silent Thiamine deficiency epidemic even in developed countries. I encourage all of you to read this excellent article about it.

It’s common knowledge that severe Thiamine deficiency can manifest as Wernicke–Korsakoff syndrome, but note that Thiamine deficiencies are also implicated in acute heart failure (Soshin Cardiomyopathy), lactic acidosis, fatigue & physical deconditioning, peripheral including diabetic neuropathy, memory deficits, fatty liver, etc. Alcoholism may be the one condition that many clinical people associate with Thiamine deficiency ( any alcohol intoxicated or withdrawing patient gets the standard ‘banana bag’ IV), but here are other common conditions that can cause or be associated with Thiamine deficiency:

– Diabetes mellitus (due to renal losses & due to Metformin)
– Dialysis patients (dialysis losses)
– Drugs such as Diuretics that enhance urinary loss ( e.g Diuretic induced Beri-Beri )
– Dementia
– Depression & Anxiety
– Degenerative brain disorders such as Parkinsons & Huntingtons
– Diet: reduced diet (example : Cancer , Bariatric surgeries, gluten free diet , Religious fasting, severe pancreatitis, prolonged nausea etc.) or high-carb / fast-food diets which depletes our Thiamine a lot faster (For example, in Obesity)
– Smokers/Tobacco Chewers

So if such thiamine-depleted patients get sick from acute illnesses and show confusion, lethargy, generalized weakness, lactic acidosis thiamine supplementation acutely and maintenance doses for long term should be considered. Any sickness also probably leaves them very weak or deconditioned./ Also note that usually Wernicke’s encephalopathy doesn’t present with the classic triad of symptoms, and can be easily missed – so maintain a high index of suspicion in the above conditions. Here’s a good free article discussing that.