12 signs you might have a thiamine deficiency


by Meredith Arthur, MS, RD, LD, CNSC

Oct 7, 2019

Have you ever heard of thiamine? Chances are, your answer was “no.” As it turns out, this often ignored — but crucial — vitamin plays a very important role in your health.

What is thiamine?

Thiamine, or vitamin B1, is a crucial vitamin that helps us use the main form of carbohydrate in the body, glucose, and is used for making neurotransmitters that help nerves send information to the rest of our bodies.

Although deficiency has been thought of as rare, our refined western diet that is high in sugar, caffeine and sometimes alcohol, can lead to a thiamine deficiency.

The human body is extraordinarily designed, but can malfunction due to genetic mutations, injuries to organ systems, advancing age, environmental factors or poor nutrition. Although deficiency has been thought of as rare, our refined western diet that is high in sugar, caffeine and sometimes alcohol, can lead to a thiamine deficiency. Add on to that common medications such as lasix, metformin and pepcid, and the risk for deficiency goes up.

If a hidden thiamine deficiency develops, it is often masked as complications of conditions like diabetes and congestive heart failure. If you experience neurological decline or heart failure, it’s worth exploring your thiamine status. Ask your physician if your symptoms could just be the result of a deficiency in thiamine.

You may have a thiamine deficiency if…

Although deficiency symptoms should never be taken lightly, here is a bit of a humorous explanation of what a thiamine deficiency can look like in everyday life.

  • You stagger like you just partied hard but haven’t had a drink in 24 hours. (Ataxia)
  • You get in trouble because you called your wife “Mary” and her name is “Nancy.” (Confusion)
  • Out of the blue, you develop a bad case of snake eye (ophthalmoplegia) or someone asks you repeatedly if you are dizzy because your eyes are jiggling around in your head (nystagmus).
  • You scream at the barista because they didn’t get your triple shot mocha cappuccino right. (Irritability)
  • You take a ride in an ambulance because you just convulsed on the floor of your bathroom. This one is not funny. (Seizure)
  • Your eye doctor says that your optic nerve is swollen and that’s why you are seeing two dogs when you only have one. (Papilledema)
  • Your daughter just told you the last four digits of her new phone number for the fourth time, and you still can’t remember it long enough to put it in your phone. Actually, you can’t even find your phone. (Short term memory loss)
  • You heart is racing like you just watched a zombie apocalypse movie but you’re actually taking a nice warm bubble bath. (Tachycardia)
  •  “Just Another Manic Monday” becomes your mantra as you swing from laughing with friends to crying in your closet. (Mood changes)
  • You notice that you’ve gained five pounds in one day, and inspection of your lower legs reveals a puffed marshmallow like shape. (Edema)
  • People ask you if you just finished running around the block because you can’t catch your breath when, in reality, you were just trying to chew a few bites of your lunch. (Dyspnea)
  • Your grandchildren doodle with markers on your feet while you nap, and you don’t feel a thing. (Sensory-Motor Polyneuropathy)

Who is at risk for a thiamine deficiency?

Although thiamine deficiency is rare, some factors increase your risk level, including:

  • Taking the following drugs: furosemide, famotidine, fluoroquinolone, metformin
  • Dialysis for chronic kidney disease
  • Cancer
  • Gastric bypass surgery or removal of the jejunum
  • Binge drinking or drinking alcohol daily
  • Drinking more than 16 oz. of coffee or tea daily
  • Obesity
  • Chronic use of antacids for heartburn

Think you might have a thiamine deficiency?

Good news! If you think you may have a thiamine deficiency, talk to your doctor and take these steps now to help yourself.

  1. Limit alcohol. Alcohol decreases the absorption of dietary thiamine by at least 50 percent and can damage the lining of the intestinal tract, resulting in more malabsorption.
  2. Cut out caffeine. Coffee and tea, although less damaging to the intestinal tract, can wreak havoc on thiamine absorption.
  3. Eat the other white meat. Lean pork is an excellent source of thiamine. Three ounces of lean pork provides 0.5 mg of thiamine (~40 percent of the recommended daily allowance of 1.2 mg for adult men. The goal is 1.1 mg for adult women.)
  4. Focus on whole foods. Whole grains, peas, lentils and potatoes are good sources of thiamine. Avoid refined flours because thiamine has been removed during processing.
  5. Spare the sprouts.  Sprouted seeds, beans and nuts actually have a higher amount of a thiamine destroyer, thiaminase. It’s okay to eat these once or twice a week, but a daily intake of sprouted food items could lead to inadequate thiamine intake.
  6. Skimp on sugar. A high sugar intake will make you need more thiamine for metabolizing glucose. Avoid refined sugar such as candy, ice cream, cake and pies.
  7. Eat good sources of vitamin C. Ascorbic acid found in citrus fruits decreases the pH of the gut and enhances your absorption of thiamine.
  8. Save on supplements. Although supplements can be beneficial in thiamine deficiency, caution should be used especially if you are taking metformin. Thiamine and metformin compete for use of the thiamine transporter, THTR-2, that moves these chemicals into the body. So, using thiamine in large doses at the same time as your metformin could lead to decreased uptake of your diabetes medicine. Consult with a dietitian or your doctor regarding supplementation.
  9. Get support. And finally, if you think you may have a thiamine deficiency contributing to your heart failure or neurological problems, talk to a registered dietitian. We can screen you for symptoms of thiamine deficiency and consult with your primary care physician if they think you may be deficient. We would love to help you restore as much thiamine dependent function to your body as possible.

Got burning nutrition questions? Find a dietitian near you.

About the Author

Meredith Arthur, MS, RD, LD, CNSC, is a registered dietitian and certified nutrition support clinician on staff at Baylor Scott & White Medical Center – Grapevine.

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