Vitamin B1 – a forgotten nutrient
The ramifications of a vitamin B1 deficiency are serious, despite it not being a high-profile nutrient
BERIBERI may be a familiar name to some of us, but it is mostly a forgotten disease. It is caused by a severe lack of thiamine, also known as vitamin B1. Many of us take multivitamins or B complex vitamins but may not realise vitamin B1’s importance to our bodily functions. It helps break glucose down to form energy and is essential for nerve, muscle and heart functions. Vitamin B1 has to be supplied via food, as the body is unable to make it for itself.
Deficiencies in vitamin B1 were seen in the last 100 years, especially in Asia. This is due to a diet of white rice, which became widespread thanks to industrial processing of the grain. Prior to that, brown rice, whose outer layer of bran is a good source of vitamin B1, was more commonly consumed.
Impacts from deficiency
As there are two target organs that are affected by vitamin B1 deficiency, the condition is known as “wet” and “dry” beriberi. “Wet” beriberi affects the heart, leaving patients breathless, experiencing fast heart rates and a swelling of their feet with high levels of lactic acid in their bloodstreams. “Dry” beriberi affects the brain and nerves, so patients are weak, unsteady, unable to walk and become confused.
One of the features we see in those with vitamin B1 deficiency is confabulation, a neuropsychiatric disorder that makes someone produce false memories. For instance, sufferers may talk about spending a day with their daughter and the activities they did together, when in fact they have only sons.
We see this in alcoholics, who form one of the key groups that suffer from chronic vitamin B1 deficiency. This is because alcohol blocks the absorption of vitamin B1 from the gut into the bloodstream and from the bloodstream into cells.
As alcohol has plenty of calories but lacks vitamins or minerals, alcoholics tend to get their nutrition from “empty” calories and do not have a normal diet. They also lack magnesium in their food and lose the mineral in their urine as alcohol consumption increases urination. This makes their vitamin B1 deficiency worse because magnesium is a catalyst for vitamin B1, helping the body to absorb it.
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Severe vitamin B1 deficiency sometimes leads to a life-threatening condition where glucose accumulates as lactic acid. Such patients may end up in intensive care and may even die. So when chronic alcoholics are admitted to hospital, we prescribe intravenous vitamin B1 in mega doses.
Not just an alcoholic’s problem
Apart from alcoholics, we see vitamin B1 deficiency in those who suffer from chronic vomiting, malnutrition and anorexia nervosa, as these conditions reduce thiamine absorption. Some groups of patients who are deficient in vitamin B1, though not to the extent of a beriberi patient, may also feel unwell.
These include pregnant women who are vomiting excessively, diabetics and athletes undergoing intense training. Today, we also see deficiencies in refugee populations, ship workers living for long periods offshore and prisoners.
For first trimester pregnant women who experience nausea, there is a subgroup that endures excessive vomiting, also known as hyperemesis gravidarum. These women suffer from poor nutrition akin to starvation, so they need vitamin B1 supplementation.
Studies also show that serious amateur athletes, Olympians and Paralympians have low vitamin B1 levels. This is due to their bodies’ huge demands for energy from the breakdown of glucose, thereby requiring large amounts of vitamin B1. However, the half-life of vitamin B1 is estimated to be somewhere between nine and 18 days; and being water soluble, is easily excreted through the kidneys. Therefore, they will also need vitamin B1 supplementation.
For diabetic patients, especially those who have kidney complications, data shows that there is loss of vitamin B1 through the urine. Unfortunately, diabetics with complications already have such poor quality of life that vitamin B1 supplements can only help in some small way.
Typically, I get my patients to take 100 mg of vitamin B1 daily, especially if they drink alcohol regularly. I also get them to take magnesium supplements as the two work in tandem in this vulnerable group. Magnesium can be quite difficult to find in foods and a source would be fresh peas available in our wet markets instead of frozen peas from the supermarket.
Vitamin B1 and muscle mass
One more interesting fact is that vitamin B1 is useful in sarcopenia, which is the loss of muscle mass as we age. We are estimated to lose about half a kilogramme of muscle mass annually from the age of 40. When we lose muscle mass, we become unsteady. Our metabolic rate also drops, and we tend to put on fat because muscles are important in absorbing and metabolising most of the glucose consumed in our diet.
And this is where vitamin B1 comes in – recent data shows that taking vitamin B1 supplements will reduce the risk of sarcopenia by 22 per cent. Of course, weight-bearing exercise remains key to building muscle mass.
As can be seen, while vitamin B1 is often forgotten, its deficiency is not a thing of the past.
Hence, we have to be prepared for the longevity that lies ahead, and do everything we can to help ensure we have the best quality of life for as long as possible.
This article is part of a monthly series on health and well-being, produced in collaboration with Royal Healthcare
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