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Could You Be Missing This Critical Vitamin?

May 22, 20244 min read

Understanding Thiamine Deficiency and Its Impact on
Alcohol-Related Brain Disorders


Alcohol consumption has long been linked with various health issues, but one area that is often overlooked is its relationship with thiamine deficiency. Thiamine, or Vitamin B1, plays a critical role in brain function and cellular energy production. In this blog post, we delve into the nexus between alcohol, thiamine deficiency, and the resultant neurological disorders such as Wernicke's Encephalopathy and Beriberi. With insights from the podcast episode "Cracking Addiction," featuring Dr. Ferghal Armstrong and Dr. Richard Bradlow, we will explore these critical topics in depth.

Really, you've got to have a low threshold for giving bucket loads of thiamine... the chance of preventing irreversible brain damage outweighs a lot of those considerations." – Dr Ferghal Armstrong

The Role of Thiamine in the Body

Thiamine is a vital nutrient essential for glucose metabolism. It acts as a cofactor for several enzymes, including pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, and transketolase. These enzymes are crucial in the energy production pathway, which fuels cellular functions. Thiamine is stored in the liver and absorbed through the gut. A deficiency in thiamine disrupts these metabolic pathways, leading to severe neurological and physiological symptoms.

Alcohol's Impact on Thiamine Absorption

Contrary to the common belief that alcohol directly reduces thiamine levels, Dr. Richard Bradlow explains that the issue is multifaceted. Chronic alcohol consumption leads to a poor diet, liver dysfunction, and damage to the gut wall—all of which contribute to thiamine deficiency. Therefore, it's not merely the alcohol itself, but rather the lifestyle and physiological changes it induces that impair thiamine absorption and storage.

Wernicke's Encephalopathy: Symptoms and Diagnosis

Wernicke's Encephalopathy is a severe neurological condition resulting from acute thiamine deficiency. It is characterised by a triad of symptoms: ataxia, ophthalmoplegia, and confusion. However, as Dr. Ferghal Armstrong points out, this classic triad is present in only about 10% of cases. Therefore, any new neurological symptoms in the context of alcohol withdrawal should be considered as potential Wernicke’s and treated immediately. Delayed treatment can lead to irreversible brain damage known as Korsakoff syndrome.

Preventing Wernicke's: The Importance of High-Dose Parenteral Thiamine

In clinical settings, healthcare providers administer high-dose parenteral thiamine to individuals undergoing alcohol detoxification. This approach ensures rapid replenishment of thiamine levels and helps in preventing the onset of Wernicke’s Encephalopathy. Oral thiamine supplementation is less effective due to poor bioavailability, making parenteral administration the gold standard for acute cases.

Beriberi: Understanding Peripheral and Central Manifestations

Beriberi, another consequence of thiamine deficiency, can manifest in both peripheral and central forms. Peripheral Beriberi affects the cardiovascular and nervous systems, leading to symptoms such as heart failure (wet Beriberi) or neuropathy and muscle wasting (dry Beriberi). Central Beriberi primarily impacts the brain, manifesting as Wernicke’s Encephalopathy. A look into the history reveals that Beriberi was first identified by Jacobus Bontius, a Dutch physician, who associated its symptoms to that of sheep, leading to its name.

Global Variations in Thiamine Deficiency and Wernicke's Incidence

One fascinating insight from the podcast episode is the global disparity in Wernicke’s Encephalopathy incidence rates. Countries like France, despite high alcohol consumption, have lower incidences compared to countries like Australia. This discrepancy may be attributable to differences in diet and lifestyle, suggesting that nutritional habits play a significant role in mitigating thiamine deficiency risks.

Dietary Sources and Supplementation of Thiamine

To maintain adequate thiamine levels, it’s crucial to consume foods rich in this vitamin. Common dietary sources include cereals, pork, fish, beans, lentils, and fortified grains. For individuals with alcohol use disorder, healthcare providers often recommend thiamine supplementation. Thiamine tablets, typically taken multiple times a day, offer a straightforward way to combat deficiency. Harm reduction strategies, such as encouraging the use of multivitamin supplements, can also be beneficial, although they provide lower thiamine doses compared to specialised B1 supplements.


Thiamine deficiency is a serious consequence of chronic alcohol consumption, leading to disorders such as Wernicke's Encephalopathy and Beriberi. Understanding its critical role in energy production and neurological function underscores the importance of early detection and treatment. Adequate dietary intake, supplemented by high-dose parenteral thiamine when necessary, can significantly mitigate these risks. Awareness and knowledge dissemination, as exemplified by experts like Dr. Ferghal Armstrong and Dr. Richard Bradlow, are key to addressing this pressing health issue.

Listen to or Watch the episode below

Thiamine deficiencyWernicke's encephalopathyalcohol use disordernutritional deficiency,alcohol withdrawalthiamine absorptionneurological symptomscentral beriberivitamin B1parenteral thiaminKorsakoff syndromeWernicke's triadalcohol detox
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