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Thiamine (Vitamin B1)

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Also listed as: Vitamin B1, Thiamin
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Allithiamine, aneurine, aneurine HCl, aneurine mononitrate, antiberiberi factor, antiberiberi vitamin, antineuritic factor, antineuritic vitamin, anurine, B-complex vitamin, benfotiamine, beta-hydroxy-ethylthiazolium chloride, sulfotiamine, thiamin, thiamin chloride, thiamin diphosphate, thiamin HCl, thiamin hydrochloride, thiamin monophosphate (TMP), thiamin nitrate, thiamin pyrophosphate (TPP), thiamin triphosphate (TTP), thiamine, thiamine chloride, thiamine diphosphate, thiamine HCl, thiamine hydrochloride, thiamine monophosphate (TMP), thiamine nitrate, thiamine pyrophosphate (TPP), thiamine tetrahydrofurfuryl disulfide, thiamine triphosphate (TTP), thiaminium chloride HCl, thiaminium chloride hydrochloride.

Background
  • Thiamine (also spelled "thiamin") is a water-soluble B-complex vitamin, previously known as vitamin B1 or aneurine. Thiamine was isolated and characterized in the 1920s and thus was one of the first organic compounds to be recognized as a vitamin.
  • Thiamine is involved in numerous body functions, including nervous system and muscle functioning; the flow of electrolytes in and out of nerve and muscle cells (through ion channels); multiple enzyme processes (via the coenzyme thiamine pyrophosphate); carbohydrate metabolism; and the production of hydrochloric acid (which is necessary for proper digestion). Because there is very little thiamine stored in the body, depletion can occur quickly, within 14 days.
  • Severe chronic thiamine deficiency (beriberi) can result in potentially serious complications involving the nervous system, brain, muscles, heart, and gastrointestinal system.
  • Dietary sources of thiamine 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 thiamine, because most of the naturally occurring thiamine is lost during the refinement process.
  • Thiamine is used as part of a treatment for metabolic disorders (including subacute necrotizing encephalopathy, maple syrup urine disease, pyruvate carboxylase deficiency, and hyperalaninemia) and thiamine deficiency symptoms (including beriberi, Wernicke's encephalopathy, Korsakoff's psychosis, and Wernicke-Korsakoff syndrome), and in alcoholic individuals. It has been studied as part of a treatment for other uses, but conclusions cannot be drawn at this time.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Taking thiamine by mouth helps to temporarily correct some complications of metabolic disorders associated with genetic diseases, including subacute necrotizing encephalopathy (SNE, Leigh's disease), maple syrup urine disease (branched-chain aminoacidopathy), and lactic acidosis associated with pyruvate carboxylase deficiency and hyperalaninemia. Long-term management should be under strict medical supervision.

A


Humans are dependent on dietary intake to fulfill their thiamine requirements. Because there is very little thiamine stored in the body, depletion can occur quickly, within 14 days. Severe chronic thiamine deficiency can result in potentially serious complications involving the nervous system, brain, muscles, heart, and gastrointestinal system. Patients with thiamine deficiency or related conditions should receive supplemental thiamine under medical supervision.

A


Patients with chronic alcoholism or those experiencing alcohol withdrawal are at risk of thiamine deficiency and its associated complications and should be administered thiamine.

B


It has been suggested that thiamine should be added to total parenteral nutrition (TPN) formulations for patients who are unable to receive thiamine through other sources (such as an oral multivitamin) for more than seven days. The use of thiamine in parenteral nutrition has been mentioned in several reviews.

B


Because thiamine deficiency can result in a form of dementia (Wernicke-Korsakoff syndrome), its relationship to Alzheimer's disease and other forms of dementia has been investigated. Whether thiamine supplementation is of benefit in Alzheimer's disease remains controversial. Further evidence is necessary before a firm conclusion can be reached.

C


Thiamine-responsive megablastic anemia (TRMA) is a genetic disorder affecting thiamine transport in the body or the conversion of thiamine into its active form. DIDMOAD (Wolfram) syndrome is a rare autosomal recessive inherited disease that results in diabetes mellitus, optic atrophy, diabetes insipidus, sensorineural deafness, and occasionally thiamine-responsive megaloblastic anemia. Management, including thiamine supplementation, should be under strict medical supervision.

C


Patients with diabetes are at risk of developing hardened arteries (called atherosclerosis). This happens when cholesterol and other substances build up and clog the arteries. Thiamine has been studied as a way to help widen arteries that are too narrow. Regular intake of thiamine might help slow the progression of atherosclerosis. However, additional research is needed.

C


Active individuals who reduce intake of food might be at greater risk of vitamin deficiency, including thiamine deficiency. There is inconclusive scientific evidence for supplementation in this area.

C


Thiamine deficiency has been observed in some cancer patients, possibly due to increased metabolic needs, medication use, or malnutrition. It is not clear if lowered levels of thiamine in such patients may actually be adaptive (beneficial). Currently, it remains unclear if thiamine supplementation plays a role in the management of any particular types of cancer.

C


Preliminary evidence suggests that high dietary thiamine intake may be associated with a decreased risk of cataracts. Further evidence is necessary before a firm conclusion can be reached.

C


Preliminary research suggests thiamine supplementation has benefit for acute cerebellar ataxia following febrile illness. Further research is needed.

C


Administration of thiamine is often recommended in patients with coma or hypothermia of unknown origin, due to the possible diagnosis of Wernicke's encephalopathy.

C


Decreased serum thiamine levels have been reported in patients with Crohn's disease. It is not clear if routine thiamine supplementation is beneficial in such patients generally.

C


Thiamine may prevent diabetic complications, including complications of the nervous system, eyes, blood vessels, and kidneys. Other diabetic complications that may benefit from thiamine supplementation include increased urination, high levels of glucose in the urine, and high blood cholesterol levels. Additional research is needed in this field.

C


Based on preliminary evidence, thiamine may be effective for dysmenorrhea. Further research is needed to confirm these results.

C


Preliminary research suggests that thiamine may improve attention and motor function in patients with epilepsy. However, data are limited, and further research is needed.

C


Chronic severe thiamine deficiency can cause heart failure (wet beriberi), a condition that merits thiamine supplementation. It is not clear that thiamine supplementation is beneficial in patients with heart failure due to other causes. However, it is reasonable for patients with heart failure to take a daily multivitamin including thiamine, because some of these individuals may be thiamine deficient.

Diuretics may lower thiamine levels. Since diuretics are commonly administered to patients with heart failure, patients taking diuretics are at an increased risk of thiamine deficiency. This area remains controversial, and further evidence is necessary before a firm conclusion can be reached.

C


Vitamin B supplements have been used to treat leg cramps during pregnancy. However, additional studies are needed to determine if it is effective.

C


Mitochondrial disorders are genetic defects in mitochondrial energy production and can lead to various types of diseases. There is some evidence to suggest that thiamine may be used as part of a treatment regimen for these disorders. Well-designed research is needed before conclusions can be drawn.

C


There is preliminary evidence of clinical improvements in children with PDH following thiamine administration. Further evidence is necessary before a firm conclusion can be reached.

C


Vitamin deficiency, including thiamine deficiency, is associated with chronic renal insufficiency. Multivitamin supplementation is often recommended. However, some researchers believe individualization may be necessary. Research is needed in this field.

C


Preliminary evidence suggests that B vitamins might aid in pain reduction. However, clinical data are lacking for B vitamins and rheumatic diseases. Further research is needed.

C


While typically asymptomatic, the elderly have been found to have lower thiamine concentrations than younger people. There is limited evidence that thiamine supplementation may be beneficial in individuals with persistently low thiamine blood levels. Further research is necessary before a firm conclusion can be formed in this area.

C


A combination of indomethacin and thiamine were found to be less effective than classical acupuncture for temporomandibular disorders. Further research is needed in this field.

C


Preliminary evidence shows that supplemental thiamine is not beneficial for hip fractures.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Aging, AIDS/HIV, amnesia, antioxidant, arrhythmia, arthritis, bedwetting, Bell's palsy, blood disorders (myelodysplastic syndrome), brain damage (hepatic encephalopathy, ifosfamide-induced encephalopathy), canker sores, chronic diarrhea, circulation improvement, death and dying (sudden unexplained death syndrome), delirium, depression, Down syndrome, drug withdrawal, erectile dysfunction, fibromyalgia, filariasis, gastrointestinal disorders, Guillain-Barre syndrome, hair loss, high blood pressure, HIV support, insect repellant, kidney failure, lactic acidosis, learning, liver damage from drugs or toxins, liver disease, loss of appetite, low back pain, lung disease, malaria, memory enhancement, menstrual problems, migraine, mitochondrial diseases, mood, motion sickness, multiple sclerosis, muscle weakness (fine motor control), neuritis (associated with pregnancy), neurologic disorders, obesity (bariatric surgery), ophthalmologic disorders, optic nerve dysfunction (optic neuropathy), pain, pancreatic disorders (encephalopathy), peripheral neuropathy (associated with pellagra), poisoning, pyruvate carboxylase deficiency, pyruvate dehydrogenase deficiency, radiation-induced damage (protection from genetic changes), refeeding syndrome prevention, respiratory disorders (scleroma), stress, sudden infant death syndrome (SIDS), tetanus, tissue healing after surgery, tuberculosis, ulcerative colitis, vitamin and nutrient deficiency (dependency syndrome).

Dosing

Adults (18 years and older)

  • The U.S. recommended dietary allowance (RDA) for adults aged 19 years and older is 1.2 milligrams daily for males and 1.1 milligrams daily for females, taken by mouth. The RDA for pregnant or breastfeeding women of any age is 1.4 milligrams daily, taken by mouth. As a dietary supplement in adults, 1-2 milligrams of thiamine has been used daily, by mouth.
  • For Alzheimer's disease, three milligrams of thiamine has been used daily by mouth in three divided doses for up to one year.
  • For dysmenorrhea, 100 milligrams of thiamine has been used daily by mouth for three months.
  • For epilepsy, 50 milligrams of thiamine has been used daily by mouth for six months.
  • Thiamine is used to treat thiamine deficiency, metabolic or genetic enzyme deficiency disorders, neuropathy, and Wernicke's encephalopathy (prevention and treatment) under medical supervision.
  • For alcohol withdrawal, 100 milligrams of intramuscular (injected into the muscle) or intravenous (injected into the vein) thiamine hydrochloride has been used before administration of dextrose solutions.
  • For alcoholic liver disease patients, 100 milligrams of parenteral (injected) thiamine has been used.
  • For coma or hypothermia of unknown origin, 100 milligrams of intramuscular or intravenous thiamine has been used at the same time as hypertonic dextrose.
  • For total parenteral nutrition-induced fulminant beriberi, 100 milligrams of rapid intravenous thiamine has been used, with transfer to an intensive care unit.
  • For Wernicke-Korsakoff syndrome, the following daily doses have been used: 5-200 milligrams of intramuscular thiamine (administered in five divided doses over two days in patients with Wernicke-Korsakoff syndrome secondary to alcohol abuse); and at least 100 milligrams of intravenous or intramuscular thiamine.

Children (younger than 18 years)

  • The adequate intake (AI) for infants 0-6 months old is 0.2 milligrams, and for infants 7-12 months old, the AI is 0.3 milligrams. For children 1-3 years old, the U.S. recommended dietary allowance (RDA) is 0.5 milligrams; for children 4-8 years old, it is 0.6 milligrams; for children 9-13 years old, it is 0.9 milligrams; for males 14-18 years old, it is 1.2 milligrams; and for females 14-18 years old, it is one milligram, taken by mouth daily. The RDA for pregnant or breastfeeding women of any age is 1.4 milligrams daily, taken by mouth. Thiamine is used to treat thiamine deficiency or beriberi under medical supervision.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Rare hypersensitivity or allergic reactions have occurred with thiamine supplementation. A small number of life-threatening anaphylactic reactions have been observed with large parenteral (intravenous, intramuscular, subcutaneous) doses of thiamine, generally after multiple doses.
  • Skin irritation, burning, or itching may rarely occur at injection sites.
  • Contact dermatitis may occur with occupational exposure and may cause sensitization and lead to dermatitis-type reactions after subsequent oral or injected administrations.

Side Effects and Warnings

  • Thiamine is generally considered safe and relatively nontoxic, even at high doses. No clear tolerable upper level (UL) of intake has been established. Dermatitis or more serious hypersensitivity reactions occur rarely. Large doses may cause drowsiness or muscle relaxation.
  • Injections of thiamine may cause burning. Reactions can often be avoided by slow administration into larger veins.
  • Supplementary thiamine use in cancer patients should be under the care of a physician.
  • Use cautiously in patients with low blood pressure or in those taking blood pressure-lowering agents, as in an elderly population with subclinical thiamine deficiency, thiamine supplementation resulted in decreased systolic blood pressure.
  • Use cautiously in patients with a slow heart rate, as, in human research, thiamine pyrophosphate (TPP) has been shown to decrease heart rate.
  • Use cautiously with vasodilators (blood vessel-widening agents) in patients with high blood sugar levels or diabetes, as thiamine has been shown to improve vasodilation in these patients.
  • Avoid use of thiamine at levels higher than those commonly found in available marketed products, unless under the advice of a healthcare practitioner.
  • Avoid in patients with known allergy or hypersensitivity to any constituents in thiamine supplements.

Pregnancy and Breastfeeding

  • Thiamine is classified by the U.S. Food and Drug Administration (FDA) as Pregnancy Category C. Thiamine may be recommended by a healthcare practitioner in women who are vomiting excessively during pregnancy.

Interactions

Interactions with Drugs

  • Heavy use of alcohol can lead to thiamine deficiency and Wernicke encephalopathy.
  • Reduced levels of thiamine in the blood and cerebrospinal fluid have been reported in individuals taking phenytoin (Dilantin®) for extended periods of time.
  • Antacids may lower thiamine levels in the body by decreasing absorption and increasing excretion or metabolism.
  • Barbiturates may lower thiamine levels in the body by decreasing absorption and increasing excretion or metabolism.
  • Loop diuretics, particularly furosemide (Lasix®), have been associated with decreased thiamine levels in the body by increasing urinary excretion (and possibly by decreasing absorption and increasing metabolism). Examples of other loop diuretics include bumetanide (Bumex®), ethacrynic acid (Edecrin®), and torsemide (Demadex®). Theoretically, this effect may also occur with other types of diuretics, including thiazide diuretics such as chlorothiazide (Diuril®), chlorthalidone (Hygroton®, Thalitone®), hydrochlorothiazide (HCTZ, Esidrix®, HydroDIURIL®, Oretic®, Microzide®), indapamide (Lozol®), and metolazone (Zaroxolyn®), and potassium-sparing diuretics such as amiloride (Midamor®), spironolactone (Aldactone®), and triamterene (Dyrenium®). Effects may be most pronounced with larger doses taken over extended periods of time.
  • Tobacco use may decrease thiamine absorption and may lead to decreased levels in the body.
  • Some antibiotics destroy gastrointestinal flora (normal bacteria in the gut), which manufacture some B vitamins. In theory, this may decrease the amount of thiamine available to humans, although the majority of thiamine is obtained through the diet (not via bacterial production).
  • Oral contraceptives (birth control pills, or OCPs) may decrease levels of some B vitamins, vitamin C, and zinc in the body.
  • People receiving fluorouracil-containing chemotherapy regimens may be at risk for developing signs and symptoms of thiamine deficiency.
  • In theory, metformin may reduce thiamine activity, and taking thiamine and metformin together may contribute to the risk of lactic acidosis.
  • Thiamine has been shown to improve vasodilation (the widening of blood vessels) in patients with high blood sugar levels or diabetes. This response was not seen in patients with normal blood sugar levels. Therefore, thiamine may increase the effects of vasodilators in these patients.
  • Thiamine may also interact with Alzheimer's agents, anticancer agents, antiretrovirals, athletic performance enhancers, blood sugar-altering agents, blood pressure-lowering agents, cardiovascular agents, coma cocktail (dextrose, flumazenil, naloxone, thiamine), dichloroacetate, ifosfamide, heart rate-regulating agents, immune agents, neurologic agents, neuromuscular blocking agents (NMBAs), pain relievers, thyroid hormone, and weight loss agents.

Interactions with Herbs and Dietary Supplements

  • Consumption of betel nuts (Areca catechu L.) may reduce thiamine activity due to chemical inactivation, and may lead to signs and symptoms of thiamine deficiency.
  • Horsetail (Equisetum arvense L.) contains a thiaminase-like compound that can destroy thiamine in the stomach and theoretically causes symptomatic thiamine deficiency. Horsetail products are available without this property. The Canadian government requires that horsetail products be certified free of thiaminase activity.
  • In theory, diuretic herbs may decrease thiamine levels in the body by increasing urinary excretion.
  • Antacids may lower thiamine levels in the body by decreasing absorption and increasing excretion or metabolism.
  • Polyphenols may affect the transport of thiamine.
  • Tobacco use may decrease thiamine absorption and may lead to decreased levels in the body.
  • Thiamine has been shown to improve vasodilation (the widening of blood vessels) in patients with high blood sugar levels or diabetes. This response was not seen in patients with normal blood sugar levels. Therefore, thiamine may increase the effects of vasodilators in these patients.
  • Thiamine may also interact with Alzheimer's agents, antibacterials, anticancer agents, athletic performance enhancers, benfotiamine (a synthetic S-acyl derivative of thiamine), blood sugar-altering agents, blood pressure-lowering agents, carbonated beverages, cardiovascular agents, citrate-containing foods or beverages, contraceptives, foods containing antithiamine factors, food preservatives, heart rate-regulating agents, immune agents, neurologic agents, neuromuscular blocking agents (NMBAs), pain relievers, raw seafood, sucrose, tannin-containing beverages (coffee, tea), thyroid agents, vitamins, and weight loss agents.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Anon. From the Centers for Disease Control and Prevention. Lactic acidosis traced to thiamine deficiency related to nationwide shortage of multivitamins for total parenteral nutrition--United States, 1997. JAMA 1997;278(2):109, 111.
  2. Abbas ZG, Swai AB. Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. East Afr Med J 1997;74(12):803-808.
  3. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001880.
  4. Benton D, Fordy J, Haller J. The impact of long-term vitamin supplementation on cognitive functioning. Psychopharmacology (Berl) 1995;117(3):298-305.
  5. Cook CC, Hallwood PM, Thomson AD. B Vitamin deficiency and neuropsychiatric syndromes in alcohol misuse. Alcohol Alcohol 1998;33(4):317-336.
  6. Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse. Cochrane Database Syst Rev. 2004;(1):CD004033.
  7. Hamadani M, Awan F. Role of thiamine in managing ifosfamide-induced encephalopathy. J Oncol Pharm Pract. 2006 Dec;12(4):237-9.
  8. Kabat GC, Miller AB, Jain M, et al. Dietary intake of selected B vitamins in relation to risk of major cancers in women. Br J Cancer 2008 Sep 2;99(5):816-21.
  9. Nakasaki H, Ohta M, Soeda J, et al. Clinical and biochemical aspects of thiamine treatment for metabolic acidosis during total parenteral nutrition. Nutrition 1997;13(2):110-117.
  10. Olsen BS, Hahnemann JM, Schwartz M, et al. Thiamine-responsive megaloblastic anaemia: a cause of syndromic diabetes in childhood. Pediatr Diabetes 2007 Aug;8(4):239-41.
  11. Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2001;(3):CD002124.
  12. Ranganathan LN, Ramaratnam S. Vitamins for epilepsy. Cochrane Database Syst Rev 2005;(2):CD004304.
  13. Saif MW. Is there a role for thiamine in the management of congestive heart failure? South Med J 2003;96(1):114-115.
  14. Sohrabvand F, Shariat M, Haghollahi F. Vitamin B supplementation for leg cramps during pregnancy. Int J Gynaecol Obstet 2006 Oct;95(1):48-9.
  15. Yates AA, Schlicker SA, Suitor CW. Dietary Reference Intakes: the new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc 1998;98(6):699-706.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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