Vitamin B1 deficiency

Thiamine (vitamin B1) in its active form as thiamine pyrophosphate, acts as a co-factor for three enzymes involved in the metabolism of carbohydrates:

• pyruvate dehydrogenase, in glycolysis
• alpha-ketoglutarate dehydrogenase, in the citric acid cycle
• transketolase, in the pentose phosphate pathway

Consequently, deficiency tends to affect organs dependent on carbohydrates e.g. the CNS, liver, heart and skeletal muscle.

Body stores of thiamine are small, so a deficiency state appears rapidly if dietary intake is inadequate.

Thiamine is ubiquitous, hence deficiency is only encountered in the following circumstances:

• in countries where the only food is polished rice; this is called beri-beri. (The word 'beri' means weak in Sinhala, a language from Sri Lanka so beriberi means very weak.)
• amongst alcoholics who eat almost nothing
• in a starved patient, for example with carcinoma of the stomach

Reference

1. Whitfield KC, Bourassa MW, Adamolekun B, et al. Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs. Ann N Y Acad Sci. 2018 Oct;1430(1):3-43.