Vitamin B1 (Thiamin) Deficiency

What Is Thiamin?

[dropcap]T[/dropcap]hiamin, also called vitamin B1, is an essential vitamin that is required to convert foodstuffs into energy and for the health and proper functioning of the nervous, muscular and cardiovascular systems.

In the bloodstream, 90% of active thiamin (TPP) is carried by red blood cells while 10% is transported in the bloodstream as free thiamin and thiamin monophosphate bound mostly to the protein albumin.

In the diet, animal food sources provide active thiamin while plant food sources provide free thiamin.¹

Urinary excretion of thiamin cannot be detected when vitamin intake is below the required levels. On the other hand, when intake exceeds saturation in the body, thiamin and/or its metabolites are actively excreted into urine to prevent excessive toxicity of the vitamins.²

In patients who have thiamin deficiency, the most common conditions that bring them to a clinician include neuropathies, depression, myalgia, cardiomyopathies or takes diuretics and/or eat a high carbohydrate diet.³

What Is Thiamin Deficiency In Celiac Disease and/or Gluten Sensitivity?

• Relationship between thiamin deficiency and celiac disease. Thiamin deficiency is a classic symptom of celiac disease that results when the level within cells is too low to meet needs of the body for this crucial vitamin which is caused by malabsorption.
• Relationship between thiamin deficiency and features. This deficiency is characterized by these impairments: 1) carbohydrate metabolism causing muscular weakness with wasting leading to loss of calf and thigh muscle; 2) cardiac function causing heart enlargement with high blood pressure leading to heart failure; and 3) neural function causing dulled intellect leading to dementia.
• Relationship between thiamin deficiency and and niacin deficiency. Thiamin deficiency commonly accompanies and can cause vitamin B3 (niacin) deficiency.
• Relationship between thiamin deficiency and mineral deficiencies. Thiamin deficiency is made worse by deficiencies of magnesium and manganese because these nutrients are required for the functions of thiamin.
• Relationship between thiamin deficiency and diet. A study investigating life-long gluten-free diet in celiac disease patients shows that inadequate intake of thiamin is common (more than 10% of study patients) and so is magnesium (10%) which may relate to habitual poor food choices in addition to inherent deficiencies in the gluten free diet. “Dietary education should also address the achievement of adequate micronutrient intake.”⁴
• Relationship between thiamin deficiency and increased need in children. Research shows that in children with celiac disease, there is a need for greater than normal intake of thiamin because of a greater than normal urinary excretion of thiamin.⁵

How Prevalent Is Thiamin Deficiency In Celiac Disease and/or Gluten Sensitivity?

Thiamin deficiency is common in patients with untreated celiac disease.⁶

Thiamin deficiency is also common in treated patients with celiac disease.

Concerning the adequacy of thiamin intake of patients on a gluten free diet, more than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin intakes.  More than one in 10 newly-diagnosed men had inadequate thiamin intakes. Dietary education should address the achievement of adequate micronutrient intake.⁷

A German study found that the average daily micronutrient intake of vitamin B1 in male and female patients was significantly lower in celiac patients compared to the non-celiac population. Based on these findings, regular (laboratory) monitoring of celiac patients should be recommended.⁸.

What Are The Symptoms Of Thiamin Deficiency?

Thiamin deficiency is marked by these symptoms:

Metabolic:

• Decreased urine output.
• Fatigue.
• Feeling cold.
• Loss of appetite.
• Weight loss.

Digestive:

• Abdominal discomfort.
• Constipation.
• Indigestion.

Neurologic:

• Anxiety.
• Apathy.
• Confusion.
• Decline in thinking skills (such as impaired math skills, impaired memory, poor concentration, difficulty recalling information, faulty judgment).
• Depression.
• Irritability.
• Low morale.
• Insomnia (sleep disturbances).
• Pain or tingling in arms and leg.

Muscular:

• Cardiomyopathies.
• Pain over heart.
• Peripheral neuropathy.
• Progressive heart failure.
• Weakness.
• Weakness of eye muscles.

Advanced thiamin deficiency can take the course of “wet,” “dry,” or “cerebral” beriberi syndromes, which if untreated progresses to death.

Late beriberi syndomes include these symptoms:

• Signs of “dry” beriberi are neuromuscular changes in both legs: loss of feeling in toes, burning of the feet, muscle cramps in calves, with tenderness and pain. Later, loss of knee jerk reflex, tense calf muscles, atrophy of calf and thigh muscles occur.
• Signs of “wet” beriberi are cardiovascular changes caused by death of heart tissue: vasodilatation and warm extremities, tachycardia (fast heart beat), sweating, and cardiomegaly (heart enlargement leading to heart failure) causing edema of face, legs, trunk and serous cavities with lung congestion, high blood pressure, distended neck veins, fatigue and inactivity.
• Signs of “cerebral beriberi” (Wernicke’s Syndrome) are caused by central nervous system damage which is a medical emergency requiring prompt injection of thiamin by vein or intramuscular shot.

Symptoms of cerebral beriberi result from acute deficiency on top of chronic deficiency: mental confusion, loss of fine motor control, loss of eye coordination due to eye muscle paralysis (ophthalmoplegia), weakness, vomiting, hypothermia, dementia, loss of speech sounds from the larynx (aphonia), and confabulation, then loss of immediate memory, disorientation, nystagmus, staggering walk, fever, coma and then death.

How Does The Body Get Thiamin?

• Thiamin must be supplied in the diet daily.  This vitamin is absorbed from the proximal (beginning) small intestine both by active transport at low doses and passive transport at doses more than 5 mg per day.¹
• Active transport of thiamin is inhibited by alcohol consumption.¹

Note: Absorption of thiamin is inhibited by folate deficiency.

What Does Thiamin Do In The Body?

These Are the Functions of Thiamin:

• Essential for the metabolism of carbohydrates to generate energy.
• Essential for the production of the nucleic acids DNA and RNA (genetic materials).
• Produces the major source of cellular NADPH, an important enzyme used in building fatty acids and other pathways, such as, enabling hemoglobin to carry oxygen.
• Localized in nerve cell membranes and plays a role in transmission of nervous impulses.
• Essential for formation of acetylcholine (a major neurotransmitter).

How Does Thiamin Deficiency Develop In Celiac Disease and/or Gluten Sensitivity?

• Thiamin deficiency in celiac disease results from impaired absorption.
• Accompanying folic acid deficiency inhibits thiamin absorption from the gut and activation in the body.
• Prolonged diarrhea depletes thiamin.

Does Thiamin Deficiency Respond To Gluten-Free Diet?

Yes. Celiac disease-related thiamin deficiency responds quickly to nutritious gluten free diet containing adequate thiamin.

 6 Steps To Correct Thiamin Deficiency:

• [dropcap]1[/dropcap]Meet, or Exceed the RDA (Recommended Dietary Allowances) for Thiamin in milligrams (mg) per day:

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0.5 mg for children 1-3 years;

0.6 mg for children 4-8 years;

0.9 mg for children 9-13 years;

1.2 for male teens 14-18 years; 1.0 mg for female teens 14-18 years;

1.2 mg for males 19 years and older; 1.1 mg for females 19 years and older;

1.4 mg for pregnant and breastfeeding women.[/box]

• [dropcap]2[/dropcap]Diet – Include Food Sources Richest in Thiamin:

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Plant sources:

• Nutritional yeasts…most
• Sunflower seeds.
• Peanuts.
• Soybeans.
• Watermelon.
• Nuts (almonds, pecans, walnuts).
• Rice bran.
• Peas.
• Whole grains (brown rice, organic corn).
• Enriched grain and grain products (cereals).
• Beans.
• Avocado.

Animal sources:

• Pork.
• Organ meat.
• Salmon.
• Halibut.
• Chicken.
• Beef.
• Egg.¹

Chef’s Note: Thiamin is lost to high heat, light, air, and alkalinity. Cold and acid preserve thiamin.

Refrigerate eggs at all times. If recipe calls for warm eggs, transfer them from the fridge to a bowl with hot water to warm.

Repackage meat using aluminum foil to avoid air pockets and keep out light before freezing. (Place the meat on the shiny side to avoid the plastic coating on dull side.) Store other foods in a cool place or the fridge, especially whole grains and flours, seeds and nuts. It is best to repackage these foods in a closed dark container to keep out light.

When cooking, cover the pot, use low to medium heat, the smallest amount of water, and do not add baking soda to cooking water. Consume the cooking liquids which will contain thiamin.[/box]

• [dropcap]3[/dropcap] Diet – Avoid, Limit, or Eat Separately These Foods That Deplete or Interfere With Absorption:

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• Excessive ingestion of raw fresh-water fish and shellfish like clams and oysters. An anti-thiamin factor in them called thiaminase binds thiamin. Good news – cooking destroys thiaminase, so always cook fish and seafood.
• Blueberries (contain anti-thiamin factors). Cook first or eat separately as a snack.
• Red cabbage (contains anti-thiamin factors). Cook first.
• Coffee, tea, excessive alcoholic drinks block absorption of thiamin. Do not drink these with a meal.

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• [dropcap]4[/dropcap]Monitor Medications That Deplete or Interfere With Absorption:

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Here are common medications that deplete thiamin. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

• Anti-Convulsants (Phenobarbital and Barbituates).
• Anti-Convulsants (Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon®).
• Anti-Hypertensives (Catapres®, Aldomet).
• Loop Diuretics (Lasix®, Bumex®, Edecrin®).[/box]

• [dropcap]5[/dropcap]Manage Nutritional Supplements to Obtain Thiamin:

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• Thiamin is available without prescription in tablet form as thiamin hydrochloride and as part of multivitamin supplements to be taken by mouth. 100% to 300% of RDA is reasonable for most people.
• Natural vitamin B1 preparations made from food are superior to the synthetic forms that are chemically produced.
• Avoid any preparation that contains these harmful chemicals most of which are derived from benzene (a toxic hydrocarbon, C6H6): benzoic acid, methyparaben (found in breast cancer tissue, in eye drops it damages the eye surface), propylparaben, paraben, polyethylene glycol, propylene glycol (propanediol), polysorbate 60.

Toxicity: There is no evidence of thiamin toxicity from oral administration, except for development of sensitivity in very rare cases.

However, excessive intake of thiamin, unless prescribed, is a poor idea because excess thiamin is excreted through the urine and depletes magnesium and manganese in the process.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a kitchen cabinet or refrigerator – not in the bathroom “medicine chest”and not on the kitchen table.

Other deficiencies that may develop if thiamin deficiency is not corrected:

• Magnesium.
• Pyridoxine (vitamin B6).

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• [dropcap]6[/dropcap]Other Supplements That Deplete or Interfere With Absorption:

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• None reported. Check with your pharmacist.[/box]

Medical Research Findings On Thiamin Deficiency In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

“Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with celiac disease.” This study investigating life-long gluten-free diet (GFD) in celiac disease patients aimed to determine the nutritional adequacy of the ‘no detectable gluten’ diet. Results show that inadequate intake of thiamin is common (more than 10%) and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. “Dietary education should also address the achievement of adequate micronutrient intake.”

A seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18-71 years, 24% male) studied prospectively over 12 months on GFD. Historical pre-celiac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data.

RESULTS: Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation.  Because dietary intake patterns at 12 months on a GFD are similar to longer-term intake, researchers stress that fortification of GF foods also need to be considered.”⁴

“Features of B group vitamin metabolism and criteria for providing them to children suffering from celiac disease.” This study investigating the metabolic relationship between the concentration of B vitamins, the blood activity of vitamin B-dependent enzymes and the urinary excretion of their metabolites in 14 children who suffered from celiac disease, determined that the criteria for vitamin B1 intake in the diet of these children differ from those in healthy children of the same age.  Children were of both sexes whose age was 4.5-10 years.

Results: The normal value of TDP (thiamin diphosphate ) effects on the body is achieved in celiac children with higher thiamine excretion, which is more than 12 micrograms/hour, so there is a greater loss to urine. [Thiamin diphosphate is the active form which catalyzes vital metabolic actions in all living cells].⁹

“Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease.” This study investigating the nutritional adequacy of the ‘no detectable gluten’ diet found that dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies in the gluten free diet.

A seven-day prospective food intake was assessed in 55 patients who were adherent to a gluten free diet for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18-71 years, 24% male) studied prospectively over 12 months on gluten free diet.

Results: Nutritional intake was similar between groups. Mineral and vitamin deficiencies were common. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin intakes and  folate, vitamin A, magnesium, calcium and iron intakes.  More than one in 10 newly-diagnosed men had inadequate thiamin intakes and folate, magnesium, calcium and zinc intakes.  Dietary education should address the achievement of adequate micronutrient intake.¹⁰

“Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey.” This study investigating the nutritional composition of a gluten free diet and to compare it with non-gluten free diet in a representative German non-celiac disease population found that male and female celiac patients in Germany have inadequate nutrient intakes. Data from 88 patients aged 14-80 years who filled out a prospective 7-day food diary and a questionnaire were analyzed and compared to the DACH reference values and to data from the German National Diet and Nutrition Survey (NVS II).

Results: The average daily micronutrient intake of male and female patients, specifically of vitamin B1, B2, B6, folic acid, magnesium and iron, was significantly lower in celiac patients compared to the NVS II. Based on these findings, regular (laboratory) monitoring of celiac patients should be recommended.¹¹.

Sources:

1. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩] [↩] [↩]
2. Shibata K, Hirose J, Fukuwatari T. Relationship Between Urinary Concentrations of Nine Water-soluble Vitamins and their Vitamin Intakes in Japanese Adult Males. Nutr Metab Insights. 2014 Aug 5;7:61-75. doi: 10.4137/NMI.S17245. [↩]
3. Spectracell Labs, Inc. [↩]
4. Shepherd SJ1, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. [↩] [↩]
5. Kodentsova VM, Uspenskaia ID, Vrzhesinskaia OA, Kharitonchik LA, Sokol’nikov AA, Iakushina LM, Makarova IB, Spirichev VB. Features of B group vitamin metabolism and criteria for providing them to children suffering from celiac disease. Vopr Med Khim. 1995 Jul-Aug;41(4):41-5. [↩]
6. Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365. [↩]
7. Shepherd SJ, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. [↩]
8. Martin J, Geisel T, Maresch C, Krieger K, Stein J. Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion. 2013;87(4):240-6. doi: 10.1159/000348850. [↩]
9. Kodentsova VM, Uspenskaia ID, Vrzhesinskaia OA, Kharitonchik LA, Sokol’nikov AA, Iakushina LM, Makarova IB, Spirichev VB. Features of B group vitamin metabolism and criteria for providing them to children suffering from celiac disease. Vopr Med Khim. 1995 Jul-Aug;41(4):41-5. [↩]
10. Shepherd SJ, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. Epub 2012 Nov 30. [↩]
11. Martin J, Geisel T, Maresch C, Krieger K, Stein J. Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion. 2013;87(4):240-6. doi: 10.1159/000348850. Epub 2013 Jun 6 [↩]