Mild thiamine deficiency may be difficult to detect, with symptoms such as headaches, irritability, and fatigue and in children, poor growth. Today, thiamine deficiency in industrialized nations can manifest differently and can go unnoticed by some healthcare professionals if they are not familiar with it. Heart failure and edema occur in cases of wet beriberi.1-3 Lactic acidosis, hypotension, and muscle wasting characterize dry beriberi.

Symptoms include anorexia, weight loss, muscle weakness, an enlarged heart, and mental abnormalities such as decreased short-term memory and confusion. Thiamine deficiency has been historically known as the disease beriberi, occurring in areas where food supply is inadequate or of poor quality, such as in regions where the staple of the diet is polished rice. Nerve and brain functions depend on thiamine’s metabolic roles in energy synthesis from glucose, production of myelin, and synthesis of amino acids and neurotransmitters.1-4 For example, it is necessary for the conversion of pyruvate to acetyl coenzyme-A for entry into the Krebs cycle for energy production. TPP functions in decarboxylation of alpha-keto acids and transketolation reactions of hexose and pentose phosphates. Thiamine functions chiefly as thiamine pyrophosphate (TPP), sometimes referred to as thiamine diphosphate, a coenzyme in the metabolism of carbohydrates and branched-chain amino acids. Urinary excretion increases when serum levels elevate and decreases when serum levels are lower. The biological half-life is estimated to be nine to 18 days, and the average adult body contains approximately 30 mg. Thiamine is carried in erythrocytes and plasma. Past research indicates that intestinal absorption of thiamine occurs for only a small percentage of a high oral dose and declines at intakes above 5 mg. Intestinal absorption of thiamine occurs mainly in the jejunum, by carrier-mediated active transport at low concentrations, and by passive diffusion at higher concentrations. Thiamine, also known as vitamin B1 and called aneurin, was the first vitamin to be discovered. RDs can be instrumental in the prevention and treatment of thiamine deficiency by being aware of risk factors, symptoms, physiology, and metabolic functions of thiamine as well as available products.

This article highlights one particular vitamin-thiamine-that is of great importance when treating patients who are severely malnourished, even in modern industrialized nations today. Of course, we weren’t yet knowledgeable about the myriad disease states and socioeconomic situations that can result in severe nutrient deficiencies. She made a statement that, although inaccurate, I have not forgotten: “There is no reason to be a dietitian nowadays because there are no deficiencies anymore. In 1979, as college undergrads, a friend and I were discussing our chosen majors while walking to the campus bookstore. Thiamine Deficiency - RDs Are Key Players in Prevention and Treatment

Give thiamine before glucose