Not enough vitamin B1 can cause brain damage
A deficiency of a single vitamin, B1 (thiamine), can cause a potentially fatal brain disorder called Wernicke encephalopathy.
Symptoms can include confusion, hallucinations, coma, loss of muscle coordination and vision problems such as double vision and involuntary eye movements. Untreated, the condition can lead to irreversible brain damage and death, according to neurologists at Loyola University Medical Center.
In the developed world, Wernicke encephalopathy typically occurs in people who have disorders such as alcoholism and anorexia that lead to malnourishment.
Wernicke encephalopathy is an example of the wide range of brain diseases, called encephalopathies, that are caused by metabolic disorders and toxic substances, according to a report by Loyola neurologists Matthew McCoyd, MD, Sean Ruland, DO and Jose Biller, MD in the journal Scientific American Medicine.
Acute encephalopathy has a rapid onset of between hours and days. It is commonly due to toxic and metabolic factors.
“Toxic and metabolic encephalopathies may range in severity from the acute confusional state to frank coma,” McCoyd, Ruland and Biller write. “As permanent injury may occur, an organized approach is needed to make an accurate and rapid diagnosis.”
Thiamin (also spelled “thiamine”) is a water-soluble B-complex vitamin, previously known as vitamin B1 or aneurine. Thiamin was isolated and characterized in the 1920s, and thus was one of the first organic compounds to be recognized as a vitamin.
Thiamin is involved in numerous body functions, including: nervous system and muscle functioning; flow of electrolytes in and out of nerve and muscle cells (through ion channels); multiple enzyme processes (via the coenzyme thiamin pyrophosphate); carbohydrate metabolism; and production of hydrochloric acid (which is necessary for proper digestion). Because there is very little thiamin stored in the body, depletion can occur as quickly as within 14 days.
Severe chronic thiamin deficiency (beriberi) can result in potentially serious complications involving the nervous system/brain, muscles, heart, and gastrointestinal system.
Dietary sources of thiamin include beef, brewer’s yeast, legumes (beans, lentils), milk, nuts, oats, oranges, pork, rice, seeds, wheat, whole grain cereals, and yeast. In industrialized countries, foods made with white rice or white flour are often fortified with thiamin (because most of the naturally occurring thiamin is lost during the refinement process).
The hallmark of toxic and metabolic encephalopathies is altered sensorium. This can range from mild attention impairment, such as difficulty spelling a word backwards, to coma.
Toxic encephalopathy can be caused by illegal drugs, environmental toxins and reactions to prescription drugs.
Thiamine deficiency is among the nutritional deficiencies that can cause brain diseases such as Wernicke encephalopathy. The condition likely is underdiagnosed. Although clinical studies find a rate of 0.13 percent or less, autopsy studies show a prevalence as high as 2.8 percent.
Vitamin B1 (thiamine)
Vitamin B1, also called thiamine or thiamin, is one of 8 B vitamins. All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy. These B vitamins, often referred to as B complex vitamins, also help the body metabolize fats and protein. B complex vitamins are needed for healthy skin, hair, eyes, and liver. They also help the nervous system function properly, and are needed for good brain function.
All B vitamins are water-soluble, meaning that the body does not store them.
Like other B complex vitamins, thiamine is sometimes called an “anti-stress” vitamin because it may strengthen the immune system and improve the body’s ability to withstand stressful conditions. It is named B1 because it was the first B vitamin discovered.
Thiamine is found in both plants and animals and plays a crucial role in certain metabolic reactions. Your body needs it to form adenosine triphosphate (ATP), which every cell of the body uses for energy.
It’s rare to be deficient in thiamine, although alcoholics, people with Crohn’s disease, anorexia, and those undergoing kidney dialysis may be deficient. Symptoms of thiamine deficiency are fatigue, irritability, depression and abdominal discomfort. People with thiamine deficiency also have trouble digesting carbohydrates. That allows a substance called pyruvic acid to build up in their bloodstream, causing a loss of mental alertness, difficulty breathing, and heart damage, a disease known as beriberi.
Beriberi
The most important use of thiamine is to treat beriberi, which is caused by not getting enough thiamine in your diet. Symptoms include swelling, tingling, or burning sensation in the hands and feet, confusion, trouble breathing because of fluid in the lungs, and uncontrolled eye movements called nystagmus. People in the developed world usually don’t get beriberi because foods such as cereals and breads are fortified with vitamin B1.
Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome is a brain disorder caused by thiamine deficiency. Wernicke-Korsakoff is actually two disorders: Wernicke’s disease involves damage to nerves in the central and peripheral nervous systems. It is often caused by malnutrition due to alcoholism. Korsakoff syndrome is characterized by memory problems and nerve damage. High doses of thiamine can improve muscle coordination and confusion, but rarely improves memory loss.
Cataracts
Preliminary evidence suggests that thiamine - along with other nutrients - may lower risk of developing cataracts. People with plenty of protein and vitamins A, B1, B2, and B3 or niacin in their diet are less likely to develop cataracts. Getting enough vitamins C, E, and B complex vitamins - particularly B1, B2, B9 or folic acid, and B12 - may further protect the lens of your eyes from developing cataracts. More research is needed.
Alzheimer’s disease
Lack of thiamine can cause dementia in Wernicke-Korsakoff syndrome. So researchers have speculated that thiamine might help Alzheimer’s disease. Scientific studies have not always shown any benefit from thiamine, however. More research is needed before thiamine can be proposed as a treatment for Alzheimer’s disease.
Heart failure
Thiamine may be related to heart failure because many people with heart failure take diuretics (water pills), which help rid the body of excess fluid. But diuretics may also cause the body to get rid of too much thiamine. A few small studies suggest that taking thiamine supplements may help. A multivitamin, taken regularly, should provide enough thiamine.
“Particularly in those who suffer from alcoholism or AIDS, the diagnosis is missed on clinical examination in 75 to 80 percent of cases,” the Loyola neurologists write.
Untreated, Wernicke encephalopathy can lead to Korsakoff syndrome (KS), characterized by profound memory loss and inability to form memories - patients often can’t remember events within the past 30 minutes. Other KS symptoms can include apathy, anxiety and confabulation (fabricating imaginary experiences to compensate for memory loss).
About 80 percent of Wernicke encephalopathy patients develop KS, and once this occurs, only about 20 percent of patients recover.
Wernicke encephalopathy is a medical emergency that requires immediate thiamine treatment, either by injection or IV. “In the absence of treatment, deficiency can lead to irreversible brain damage and death with an estimated mortality of 20 percent,” the Loyola neurologists write.
What are the possible side effects of Thiamine (Vitamin B1)?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have a serious side effect such as:
blue colored lips
chest pain, feeling short of breath
black, bloody, or tarry stools; or
coughing up blood or vomit that looks like coffee grounds
Less serious side effects may include:
nausea, tight feeling in your throat
sweating, feeling warm
mild rash or itching
feeling restless; or
tenderness or a hard lump where a thiamine injection was given
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
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McCoyd is an assistant professor, Ruland is an associate professor and Biller is a professor and chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine.
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Jim Ritter
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Loyola University Health System
@LoyolaHealth