Why Do We Give Thiamine to Alcoholics?

What Is Thiamine?

Thiamine or thiamin belongs to the family of B vitamins. Referred to as Vitamin B1, thiamine is water-soluble and helps the body with biochemical reactions that enable enzymes to convert carbohydrates into glucose (a simple sugar for fuel). The body then uses the glucose to generate energy and aid in the healthy growth, development, and function of cells. 

Thiamine is available naturally in plants and food, as well as in vitamin supplements. In serious cases, a patient may need intravenous (IV) thiamine injections. The following comprises the main types of food that have thiamine:

• Whole grains - breads and cereals are the leading source of thiamine. 
• Meat - pork is another common food product that has thiamine. 
• Fish - 3 oz. of trout cooked in dry heat can offer 33% of the daily value (DV). 

In accordance with FDA guidelines, any type of food that offers more than 20% of the DV may be a high source of a certain nutrient. A lower percentage of the DV, nonetheless, can be beneficial to a healthy diet.  

In the United States, it is common to find breads, cereals, and infant formulas fortified with this dietary vitamin. For this reason, it is also rare that an individual suffers from a thiamine deficiency. 

Those with an extremely low intake of thiamine may present with other underlying health conditions, such as HIV/AIDs or continual, heavy drinking. Thiamine deficiency can also cause more serious illnesses and sometimes lead to irreversible health consequences. 

Thiamine Deficiency and Alcohol 

As mentioned prior, certain health conditions can lead to increased excretion rates or decreased absorption of thiamine. This, in turn, results in insufficient thiamine levels. 

Alcohol use disorders contribute to thiamine deficiency. Approximately 80% of chronic alcoholic patients suffer from thiamine deficiency, as ethanol (the type of alcohol found in alcoholic beverages) lessens gastrointestinal absorption of the B1 vitamin. Similarly, chronic alcohol consumption can contribute an impaired utilization of the vitamin in the body, as well as malnutrition. 

In one study exploring the mechanisms of vitamin deficiency in chronic alcohol misusers and the development of the Wernicke-Korsakoff syndrome, the degree of malabsorption varied among study subjects, with some individuals absorbing almost no thiamine. 

Thiamine-deficient individuals can experience a host of symptoms. Early symptoms include:

• Fatigue
• Weakness 
• Weight Loss
• Anorexia
• Emotional disturbance, which may comprise mental confusion, short-term memory loss, and much more. 

Over time, if an individual continues with a poor thiamine status, there is an elevated risk of suffering any of the four types of beriberi (a disease that originates due to a thiamine deficiency in the body):

• Dry (paralytic or nervous) — Individuals with dry beriberi can suffer from neuropathy (damage/dysfunction of one or more nerves in the nervous system that leads to numbness or tingling sensations in the legs and arms). Individuals may also experience exaggerated reflexes. 
• Wet (cardiac) — Besides neurological symptoms, those with wet beriberi may experience cardiovascular issues such as a racing heart rate, enlarged heart, intense swelling (edema), dyspnea (trouble breathing), and heart failure. 
• Gastrointestinal — Symptoms of gastrointestinal beriberi can include nausea, vomiting, and severe abdominal pain, as well as lactic acidosis (the accumulation of lactate in the body). 
• Cerebral — This form of disease can include Wernicke's encephalopathy (cerebellar dysfunction) and Korsakoff’s psychosis, which can cause brain damage. To diagnose the former, clinicians consider three primary symptoms, including abnormal eye movements, stance and gait ataxia (lack of muscle coordination ability that affects a person’s way of walking), and cognitive impairments. When left untreated, Wernicke's encephalopathy gives rise to Korsakoff’s psychosis, a chronic memory disorder. Together, the condition is referred to as Wernicke-Korsakoff syndrome. 

Thiamine is a critical vitamin that may reduce diabetic complications, benefit people with heart failure, and play a role in the onset of Alzheimer’s disease. 

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome (WKS) is a medical condition that is closely associated with alcohol abuse. Unlike Wernicke’s encephalopathy, WKS presents with amnesic symptoms, confusion, and a loss of recent and working memory (Korsakoff’s psychosis). It is a severe brain disorder that can even include seizures in rare cases. 

WKS requires immediate administration of high doses of thiamine to mitigate the effects of the disease, such as eye symptoms. In more severe cases, in which clinical symptoms have been present for an extended period, improvements in motor coordination skills and memory may be minimal. 

Treatment for Thiamine Deficiency: Why Do We Give Thiamine to Alcoholics? 

Alcohol dependence and abuse can lead to an individual’s inability to adequately absorb thiamine. Thiamine deficiency is common among those who drink excessive amounts of alcohol. 

When an alcohol-dependent patient does not meet the daily value recommended for thiamine intake for a prolonged time, the individual can then suffer from the medical conditions mentioned prior. 

In the case of alcoholics, clinicians may prescribe oral thiamine to offset the effects of the vitamin deficiency. However, parenteral thiamine supplementation (administered in the body apart from the mouth, like an IV) is the ideal line of treatment to replenish thiamine stores immediately and prevent any clinical symptoms or disorders from worsening. 

Parenteral thiamine supplementation does not result in recovery in approximately 25% of those with Wernicke-Korsakoff Syndrome.

Alcohol Addiction Treatment Options

If you or a loved one is suffering from an alcohol addiction, there is a range of options available that can place you on the path to recovery. You can select from the following:

• Detoxification programs — when you stop drinking you may go through severe alcohol withdrawal symptoms. Detox programs allow a medical professional to monitor your health and progress and prescribe appropriate actions. Medically Assisted Treatments (MAT) can also help someone detox from alcohol.
• Inpatient treatment — This line of treatment will provide professional support as you work through your addiction. In-patient facilities may also offer a host of activities to make the recovery experience more pleasant. 
• Support groups — Support groups provide refuge and encouragement among those who have suffered from a prior alcohol addiction. They may serve as an emotional outlet to ensure you stay clean.