Though you might sometimes drink to forget, for an unfortunate percentage of heavy drinkers, the drink can lead to permanent memory loss and irreversible brain damage – and since prevention is as easy as keeping vitamin levels in balance, this tragedy is heartbreakingly avoidable.
If you drink heavily, you should consider adding a thiamine supplement to your daily diet to compensate for alcohol’s deleterious effects on thiamine absorption, and to prevent the very scary consequences of serious thiamine deficiency.
However, you also need to remember that though thiamine supplements reduce your risks, at a certain point, alcohol damage may compromise absorption capacity to a point where oral supplements alone won’t prevent deficiencies. At this point, only thiamine injections can restore optimal levels.
Read on to learn more:
- What is thiamine, why do we need it and why are heavy drinkers at such high risk to be thiamine deficient?
- How can you spot a thiamine deficiency or its consequences (it’s not easy)?
- How can you prevent a deficiency? Plus, information on supplements and on the limitations of supplements.
What Is Thiamine?
Thiamine is just another term for vitamin B1. You can find thiamine naturally in foods like breads, nuts, meat, yeast, beans and cereal grains.
The body stores a small amount of thiamine in the liver, but this can run out within a couple of weeks so it’s important to get some thiamine on a daily basis to maintain bodily stores.
Why Should Heavy Drinkers Care about Thiamine?
Thiamine deficiency is dangerous. Chronic thiamine deficiency can cause biochemical changes in the brain and Wernicke’s encephalopathy - and if Wernicke's goes untreated, it can cause the structural lesions and permanent brain damage of Korsakoff syndrome (also known as wet brain – a permanent condition of memory loss/amnesia).
Although there are many possible origins of thiamine deficiency, in developed nations, alcohol abuse is far and away the leading cause - alcoholics are 8 to 10 times more likely to have thiamine deficiency than people from the general population.1
Untreated Wernicke's has fairly grim outcomes. Untreated, it leads to death in 20% of cases and Korsakoff's in 85%; and 25% of those with Korsakoff syndrome will develop symptoms severe enough to require long-term institutionalization.2
Why Do Heavy Drinkers Need Extra Thiamine?
If you drink heavily, you are at high risk of thiamine deficiency – the National Institute of Health estimates that between 30% and 80% of alcoholics are deficient in this essential vitamin. Since thiamine deficiency can lead to Wernicke's and wet brain, this is a fairly worrisome statistic.3
So what is it about heavy drinking that leads to such problems with thiamine?
Well, healthy adults need between 1-2 mg of thiamine from dietary sources on an average daily basis and the body stores between 30 to 50 mg of thiamine in the liver to act as a buffer for temporary shortfalls of this essential vitamin. Over time, heavy drinkers may deplete thiamine in the liver as they fail – day after day – to absorb sufficient thiamine from dietary sources. The reasons for this can include:
- Diets become high in alcohol calories and lower in food calories. Although alcohol is high in carbohydrates it contains no thiamine. As non-alcohol food intake decreases, so does your thiamine intake.
- Alcohol damage reduces the liver's thiamine holding capacity (and this is a progressive reduction – as damage worsens, thiamine capacity declines).
- Liver damage also reduces the liver’s ability to activate
thiamine to thiamine pyrophosphate, which is an enzyme co-factor.
- Chronic heavy alcohol consumption can lead to regular vomiting, diarrhea or fatty stool – all digestive problems that compromise nutrient absorption.
- Heavy alcohol use also impairs cells’ ability to use what
thiamine is absorbed.4
So as alcohol damage increases, the body becomes increasingly unable to absorb and store thiamine at the same time as dietary sources become progressively reduced.
In serious situations, heavy drinkers may get little benefit from oral thiamine supplements due to digestive malfunction and storage problems. Though healthy adults need 1 – 2 mg of thiamine daily and alcoholics need more than this, studies show that malnourished alcoholics are only capable of absorbing a maximum of 0.8 mg, even when given high oral doses, when alcohol is consumed shortly beforehand.1
So because of this, if you continue to drink, it’s important to be on the lookout for signs of Wernicke's, even if you take a prophylactic thiamine supplement.
Who Is Most at Risk?
Though it’s likely that genetic variations cause increased susceptibility for Wernicke's among some drinkers, in general, it’s a disease that anyone can get, at most any time.
- People from all ethnic backgrounds seem equally at risk
- Both men and women get Wernicke's, though men are affected slightly more often (1.7:1)5
- People most commonly get Wernicke's between 30 and 70 years of age. The average age of onset is 50 years but cases are distributed across the age span.
Obviously though, the more you drink and the less thiamine you get from dietary sources, the greater your risk.
Wernicke’s Is Hard to Spot
Wernicke's can develop suddenly and problematically, the symptoms of the condition are easily confused with drunkenness. Unfortunately, in the vast majority of cases, Wernicke's goes unrecognized and untreated.6
Wernicke's symptoms include:
- Balance problems
- Double vision
- Drowsiness and diminished mental activity
- Squinting vision or eyelid dropping
- Confusion about time and location
- Leg tremor
So if symptoms that resemble drunkenness appear in the absence of alcohol consumption, this is a warning sign indicating a medical emergency. With quick treatment, Wernicke's is controllable; untreated, it can cause permanent brain damage or death.
But if someone drinks all day, how can loved-ones differentiate between normal intoxication and dangerous symptoms of Wernicke's?
- If you know how much a person normally drinks and they seem overly intoxicated given what they’ve consumed, this is also a warning sign of possible Wernicke's.7
For doctors, the motto for thiamine deficiency is, “if in doubt – treat.” While an injection of unneeded thiamine won’t do any harm, delaying needed treatment can be catastrophic.8
Heightened Risks during Alcohol Withdrawal
It’s important to supplement thiamine before going through alcohol withdrawal.
Thiamine deficiency and sudden Wernicke's risks increase during alcohol withdrawal. The body requires more thiamine during withdrawal and this can empty an already low storage tank. You can prevent problems by getting a parental injection of thiamine (or several) prior to/during early withdrawal.
The protective benefits of injected thiamine are just one more good reason for getting medical support for any alcohol quit attempts.
Reducing Your Risks
If you or someone you love drinks heavily, the best way to eliminate the risks of Wernicke's and Korsakoff syndrome are to stop or greatly reduce alcohol consumption. If this isn’t possible or acceptable, you should consider adding a daily thiamine supplement to your diet. A daily thiamine supplement will reduce but not eliminate the risk of Wernicke's (due to vitamin absorption problems associated with alcoholism, oral thiamine is not always sufficient.)9
For Prevention – How Much to Take?
Although doctors have good protocols for treating thiamine deficiencies after they occur, no one knows exactly how much daily oral thiamine it takes to prevent deficiencies in at-risk populations – like heavy drinkers or alcoholics. In fact, a 2013 Cochrane Review of available research concluded that no research evidence provides strong guidance on prophylactic thiamine dosing or frequency.10
This isn’t to say that thiamine doesn’t help – it’s just admitting that no one really knows exactly how much is optimal.
So for specific personalized recommendations, you need to talk to your doctor about thiamine and other vitamin/nutrient supplement regimens, and when doing so you have to be completely honest about how much you drink (how much you actually drink!).
- For heavy drinkers, to prevent thiamine deficiency, your doctor may recommend as much as 50 - 100 mg of oral thiamine per day. (University of Maryland Medical Center)
- A typical daily oral dose for a person with a mild thiamine deficiency might range from between 5 mg and 30 mg per day – and this could go up to 300 mg per day in severe cases. (Web MD)11
- According to the Scottish Intercollegiate Guidelines Network, heavy drinkers with poor diet should be put on an indefinite oral thiamine supplement regimen. To increase absorption, doses can be divided up into smaller incremental doses over the day. (A person with a compromised ability to absorb thiamine would get greater absorption from 2 daily doses of 50 mg than 1 daily dose of 100 mg.) 12
Because magnesium is essential for thiamine repletion, and because alcoholics are often also deficient in magnesium, you may also need to supplement this mineral on a daily basis as well.
No Complete Protection
And because daily thiamine supplements do not eliminate the risks of brain damage among active drinkers, it’s important to also watch for symptoms of sudden onset Wernicke's (and a need for emergency medical intervention - usually a high dose thiamine injection or I.V. drip).
The Safety of Thiamine Supplementation
According to the University of Maryland Medical Center, thiamine supplements are safe, even at a high daily dose of 50 – 100 mg per day (though you should talk to your doctor to make sure high-dose thiamine is right for you and to ensure that it won’t interact with any other medications or supplements that you use.)13
- At high doses, thiamine may sometimes cause stomach upset.
- You may need to also take a B complex vitamin along with thiamine, to make sure that all B vitamins stay in balance.
According to researchers at the Oregon State University Micronutrient Research for Optimum Health Linus Pauling Institute – there is no evidence that long term use of very high doses of oral thiamine (up to 200 mg per day) causes any toxic effects. In rare cases, large I.V. injections of thiamine can cause anaphylactic shock.14
So Why Don’t They Put Thiamine in Beer?
Autopsy studies show that about 2% of Americans have Wernicke’s and only a small percentage of cases found at autopsy are accurately diagnosed prior to death (depending on the study this can range from a high of 20% to as few as 1 in 100 cases.) Since 2% of Americans equates to more than 6 million people, there’s no denying the scale of the problem.15
So given the scope and extreme human costs of the situation, why don’t brewers just add small doses of thiamine to beer and other alcoholic beverages? After all, research shows that drinkers can’t differentiate between thiamine enriched and regular beer, even when brews are richly thiamine fortified.16
Well, arguments against fortification include:
- Thiamine absorption in heavy alcoholics is so compromised that fortification wouldn’t make any difference.
- Thiamine fortification might give people a false sense of security (people thinking they were getting sufficient thiamine, when due to reasons of poor absorption, they were not.)
- Adding thiamine to alcoholic beverages would increase costs
- Thiamine might adversely affect taste
- Adding vitamins to beer and other alcoholic drinks might cause people to underestimate the risks of heavy drinking and overestimate the health benefits. This could possibly lead to overconsumption.
Are these valid arguments? This up to you to decide…
Take Home Message
- For a number of reasons, heavy drinkers are at high risk for thiamine deficiency
- Thiamine deficiency can lead to the possibly fatal Wernicke’s Encephalopathy, and it’s estimated that as many as 6 million Americans have this condition.
- If you drink heavily and especially if you drink heavily and eat poorly, you can reduce your risks of a Wernicke’s by taking a daily thiamine supplement along with a complex multivitamin and mineral supplement. You should talk to your doctor to get a recommendation on how much thiamine to take on a daily basis, but in general, thiamine supplements are considered quite safe and have few interaction effects.
- Though a daily supplement will reduce your risks, heavy drinking can reduce your ability to absorb and make use of thiamine and so in some cases, people will become deficient even when taking oral supplements. In such situations, only injected thiamine can remedy the deficiency. For this reason, it’s important to get educated about the warning signs of sudden onset Wernicke’s and be ready to get an emergency thiamine injection if needed (this as medical emergency).
- 1. Thiamine Administration in Alcohol Dependent Patients
- 2. Wernicke's: The Role of Thiamine
- 3. Medline Plus: Thiamine
- 4. NIAAA: The Role of Thiamine Deficiency in Alcoholic Brain Disease
- 5. Medscape: Wernicke's Encephalopathy
- 6. Medscape: Wernicke's Prognosis
- 7. Alcohol Concern: Wernicke's Fact Sheet
- 8. Medscape: Wernicke's Workup
- 9. Medline Plus: Wernicke Korsakoff Syndrome
- 10. Cochrane Reviews: Thiamine for Wernicke's
- 11. Web MD: Thiamine
- 12. Scottish Intercollegiate Guidelines Network: Thiamine for Harmful Drinking
- 13. University of Maryland Medical Center: Thiamine
- 14. Oregon State University Micronutrient Research for Optimum Health Linus Pauling Institute
- 15. Wernicke's: Prevalence and Clinical Spectrum
- 16. Detecting Thiamine in Beer
Page last updated Feb 10, 2014