Thiamine deficiency is associated with a few important diseases. Vitamin B1 or thiamine was initially called as the anti-beriberi vitamin. Beriberi has been described in the ancient Chinese books as far back as 2697 BC. Other diseases associated with thiamine deficiency include Wernicke's korsakoff psychosis and Leigh syndrome.

What are the sources of vitamin B1 or thiamine:

Thiamine is found in large amounts in foods such as rice, legumes, and cereals. List of foods rich in thiamine include:

• Beef
• Liver
• Dried milk
• Nuts and oats,
• Oranges
• Eggs
• Seeds, legumes, and peas, and
• Yeast.

Foods are also fortified with thiamine. Some foods that are often fortified with B1 are rice, pasta, bread, cereals, and flour. Milk products, fruits, and vegetables are poor sources of vitamin B1.

Cooking can destroy thiamine.

Vitamin B1-rich foods include buckwheat, oats, bran, sunflower seeds, peas, and pistachio nuts

The half-life of thiamine is about 20 days. It is mostly found in the skeletal muscles, brain, heart and the kidneys. Because of the limited storage, continuous supplementation is required.

Diseases associated with Vitamin B1 or thiamine deficiency:

Wernicke-Korsakoff syndrome, Leigh's disease, and beriberi have all been linked to thiamine deficiency.

What is Beriberi?

Beriberi is a disease caused by thiamine deficiency. It is further classified as dry beriberi and wet beriberi. Dry Beriberi is manifested by the following symptoms:

• Involuntary eye movements
• Tingling or loss of sensation in hands and feet
• Loss of muscle function or paralysis of the lower legs
• Pain
• Mental confusion and speech difficulties
• Loss of tendon reflexes
• Vomiting
• Difficulty in walking

Wet Beriberi is manifested by cardiac failure and neuropathy:

• Increased heart rate
• High output heart failure
• Elevated jugular venous pressure
• Dyspnea (shortness of breath) on exertion
• Paroxysmal nocturnal dyspnea (PND)
• Peripheral edema (swelling of lower legs)
• Dilated cardiomyopathy

[caption id="attachment_987" align="aligncenter" width="300"] Beriberi[/caption]

symptoms of beriberi

How to treat Beriberi?

Beriberi is treated with thiamine replacement. It is given in a dose of 5 - 30 mg as an intramuscular or intravenous injection three times daily for one month.

Wernicke-korsakoff syndrome:

[caption id="attachment_988" align="aligncenter" width="267"] Wernicke-koraskoff syndrome – thiamine deficiency[/caption]

The Wernicke-korsakoff syndrome is caused by thiamine deficiency and is further divided on the basis of clinical manifestations as Wernicke’s encephalopathy and Wernicke-korsakoff syndrome. WK (Wernicke-korsakoff) syndrome is an acute condition requiring emergency treatment to prevent death. It is a triad of nystagmus, ataxia, and ophthalmoplegia. This triad is almost exclusively found in heavy alcoholics who become deficient in thiamine. Korsakoff syndrome is a chronic condition that occurs as a sequela of Wernicke’s encephalopathy. It is characterized by impaired memory and confabulation.

Wernicke's and korsakoff triad

Wernicke’s encephalopathy is managed by giving high doses of thiamine. Patients should be given thiamine first and dextrose later as glucose may precipitate the disease.

How to treat Wernicke Korsakoff syndrome and Wernicke's encephalopathy?

Treatment is via thiamine replacement in a dose of 100 mg intravenous, then 50 to 100 mg per day as an intramuscular or intravenous injection.

According to the Royal college of physicians, thiamine should be replaced along with other B-complex vitamins, vitamin C, potassium, phosphate, and magnesium.

It should be given in a dose of 500 mg intravenously three times a day for 3 days and continued for 5 days or more until clinical improvement is noticed.

Leigh syndrome or progressive subacute necrotizing encephalopathy:

Leigh syndrome or progressive subacute necrotizing encephalopathy: it presents in early childhood with ataxia, dysarthria, areflexia, muscle atrophy, and weakness.

Toxicity of vitamin B1 or thiamine:

Thiamine is rapidly removed from the body. Therefore, thiamine toxicity does not exist

Daily requirement:

RDA is 1.1 mg for women and 12 mg for men per day and 1.4 mg while nursing or pregnant.  Thiamine can be injected intramuscularly or intravenously at a dose of 50 to 100 mg every 7 to 14 days.

Thiamine (Vitamin B1 ) available brands:

• Abery
• Actamin
• AFI-B
• Aliaron D 10
• Anerex
• Aneurin-AS
• Arcavit-B!1
• B!1-Vicotrat
• B1-ASmedic
• Becaps
• Benerva
• Beneuran
• Beneurol
• Beneuron
• Bermin B
• Beta-Sol
• Beta-Tabs
• Betabion
• Betamin
• Betamine
• Bevitine
• Bevitol
• Biogen
• Dagravit B1
• Dagravit B1
• Dexabion
• Dextamina B1
• Dolo-Neurobion
• Dolo-Pangavit
• Dolo-Tiaminal
• Hiace
• Hithia
• Incremin con Hierro
• Kirin B!1
• Lifaton B1
• Lophakomp-B1
• Metabolin
• Mutsutamin
• Neo-Panlacticos
• Neuramin
• Neurobion 
• Optovite B1
• Pagavit
• Pharmaton
• Plivit B1
• Suma-B
• Thiamine Injection
• Tiamidexal
• Tiamin ”Dak”
• Tiamina
• Tiaminal
• Tolima
• Tribedoce
• Trifosfaneurina
• Vit. B1 Agepha
• Vita-B1
• Vitamin B1 Kattwiga
• Vitamin B1
• Vitamin B!1 Jenapharm
• Vitamin B1-Hevert
• Vitamin B1-Injektopas
• Vitamin B1-ratiopharm
• Vitamin B1 Biol
• Vitamin B1
• Vitanon
• Vitantial

Thiamine brands in Pakistan:

• Neurobion
• Bejectal
• Benerva
• Multibionta
• Vidylin, and many more