Why is thiamine the predominant nutritional deficiency in alcoholics?

Submitted by supinator1 t3_yaxc56 in askscience

In other malnutrition cases, it's often protein, electrolytes, or B12 that is the concern. What makes thiamine deficiency specific ot alcoholism? Does alcohol metabolism deplete thiamine? Does alcohol use reduce absorption or increase urinary excretion of thiamine? Do alcoholics favor foods that are disproportionately low in thiamine compared to other nutrients? Or is extra attention given to it due to neurologic disability from thiamine deficiency (Wernicke's encephalopathy, Korsakoff syndrome)?

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j0m1n1n t1_itfzhlg wrote

Oh! I can give you some answers here! I wrote a paper on this a couple of semesters back for a human physiology class.

  1. Alcohol interferes with absorption of thiamine in the gut.

  2. Alcohol interferes with the conversion of thiamine to thiamine pyrophosphate, which is the form that participates in the citric acid cycle.

  3. Alcoholics tend to have poor diets overall.

  4. They will often have other nutritional deficiencies as well, but thiamine deficiency in alcoholics can lead to Wernicke-Korsakoff syndrome which can cause brain damage, cognitive deficits, memory loss, and even death. So treating thiamine deficiency is often a higher priority than other deficiencies.

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BigBillyGoatGriff t1_itg3m25 wrote

I give this to ppl constantly thanks for telling me why.

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RockleyBob t1_itgtmku wrote

If you work in a rehab facility or treat addicts in a hospital, thank you for your service. I'm a success story and it's because I got good care.

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Unrealgecko t1_itgz5vw wrote

Yay! And anyone reading this: don’t wait to go. Go when the symptoms are mild; if you are turning yellow or feel your heart racing, it’s time!

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damnitmcnabbit t1_ith59hm wrote

Why is heart racing symptomatic?

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CardiOMG t1_ithggxq wrote

Alcohol is a depressant. When you are withdrawing, your nervous system is over activated. So you can have tachycardia, hypertension, tremors, etc.

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cremasterreflex0903 t1_ithewxn wrote

Possibly due to cardiogenic shock from multisystem organ failure. Without lab work and facts thsts pure speculation. Jaundice points to liver failure and tachycardia can be caused by a ton of things.

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FoThizzleMaChizzle t1_ith0p1v wrote

Super interesting! When I was 20, I visited a detox facility and there was a guy there who I was told had "wet-brain". I just now learned, after 12 years, what this actually means.

He was reduced to the level of a hallucinating child, talking about how he was about to be forced into the army, then woke up with paramedics standing over him on the sidewalk.

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[deleted] t1_itge91e wrote

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MenWhoStareAtBoats t1_ithdsw4 wrote

This is the correct answer. Another factor is that the body stores thiamine in the liver, and chronic alcoholics often have damaged livers.

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j0m1n1n t1_ithfgf5 wrote

Yes, thank you! I was trying to remember one more mechanism that I discussed in my paper. You hit the nail on the head.

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zag12345 t1_itgsq4j wrote

????? Are you ok lmfao what more do you want, you have symptoms you have a hangover every Person is different not everybody goes through the whole bandwidth

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AthrusRblx t1_itehxvl wrote

The pathophysiology hasn’t been elucidated on great detail, but we do know that chronic alcohol intake reduces the expression of the thiamine transporter genes, preventing efficient absorption of thiamine from the gut into the body. I don’t believe it’s known how the transcriptional change occurs, but alcohol and it’s metabolites are quite varied in their binding and interfere with a TON of biochemical processes compared to other drugs.

https://journals.physiology.org/doi/full/10.1152/ajpgi.00132.2010

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dridkwiw t1_itf6d7n wrote

The biologically active form of vitamin b1 (thiamine) is thiamine pyrophosphate which acts as a coenzyme in several biological pathways. Less thiamine means less ATP production because thiamine's role in dehydrogenase-catalyzed reactions involved in producing energy, so neurons become more susceptible to damage/impaired cellular function. Chronic alcoholism leads to thiamine deficiency because of impaired absorption or inadequate dietary intake (so you'd see other deficiencies that you mentioned as well) and the clinical picture is described as "beriberi", which comes in two forms and is probably why it's emphasized so much because it's a very classic presentation also as you mentioned. Hope this helps!

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frikinevil t1_itfvxfl wrote

This is very interesting. Does anyone know if vit b deficiency due to excessive alcohol can cause non epilectic seizures? Also, once the damage of deficiency occurs is it for life or can the body recover if alcohol use stops?

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j0m1n1n t1_itgoese wrote

Epileptic seizures can be a sign of Wernicke's encephalopathy (WE), which is the acute stage of Wernicke-Korsakoff syndrome.

The syndrome is more easily treated in the WE phase. At that point, it need not progress to Korsakoff syndrome. With Korsakoff, there may be improvement in signs and symptoms with treatment, but there is likely to be brain damage.

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StrongArgument t1_itgwxwf wrote

Severe alcohol withdrawal causes seizures in the same population. WK syndrome is lifelong, but some of the effects of alcoholism can be reversed.

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pennypumpkinpie t1_itgjl73 wrote

I don’t think deficiency can cause seizures but alcohol withdrawal can.

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j0m1n1n t1_itgokf1 wrote

Seizure is a potential symptom of Wernicke-Korsakoff syndrome caused by thiamine deficiency. This is distinct from seizures caused by alcohol withdrawal.

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Drfilthymcnasty t1_ith4y3c wrote

I apologize for the lack of details as it’s been years since I had pathophysiology, but I believe, due to the lack of thiamine which is a vitamin that helps in the metabolism of glucose for energy, it is actually a build up of a toxic metabolite or the inability actually use glucose thoroughly by the bran that causes the brain damage.

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