Serendipity, the common thread in many groundbreaking medical advancements, led Dutch physician Christiaan Eijkman to the discovery and cure for Beriberi in the late 1800s. Eijkman found his laboratory chickens ailing on a (circumstantially supplied) diet of polished rice, then thriving when they returned to their normal diet of unpolished rice, rich in vitamin B1.
Today, most Americans consume a diet adequate in thiamine (B1). However, a sizable population of patients who take diuretics or who have alcoholism, genetic impediments to thiamine uptake, gastrointestinal absorption disorders or HIV/AIDS can have a deficiency even with the recommended dietary intake.
Vartgez Mansourian, M.D., medical director of the Stroke Rehabilitation Program at the Vanderbilt Stallworth Rehabilitation Hospital, is studying thiamine deficiency prevalence and its association with various symptoms in stroke patients. In a preliminary records review, Mansourian found that 10 percent of stroke patients are thiamine deficient and 50 percent are borderline deficient.
Thiamine’s role and symptoms of deficiency
Thiamine is abundant in whole grains and legumes, and in certain seeds, vegetables, meats and cooked fish. It fulfills a crucial function in amino acid, fat and carbohydrate metabolism, and is critical to proper nervous system function. Rare diseases like Wernicke-Korsakoff, Leigh syndrome, nutritional optic neuropathy and maple syrup urine disease are associated with the body’s inability to utilize thiamine even with an adequate diet.
Those deficient in thiamine over several weeks can develop symptoms that include confusion, peripheral neuropathy, ataxia, facial weakness, numbness, speech difficulty and urinary incontinence.
“The biggest danger is when someone with a thiamine deficiency is admitted to the ED with confusion, and the deficiency isn’t picked up.”
“A patient may be deficient, but when the presentation is varied, it can be very difficult to diagnose,” Mansourian said. “The biggest danger is when someone with a thiamine deficiency is admitted to the ED with confusion, and the deficiency isn’t picked up. They may be given a glucose load, which in the presence of thiamine deficiency can result in metabolic encephalopathy. Or patients may be treated with anti-psychotics or other inappropriate therapies. This happens more often than people know.”
Deficiency can occur fairly readily: coffee, tea, social drinking, and certain foods like blueberries, brussels sprouts and raw fish or shellfish can substantially impact thiamine absorption. Even sub-acute thiamine deficiency can cause symptoms of peripheral edema and mixed motor and sensory neuropathy.
Measuring the scope of the problem
Mansourian and his team are now conducting a retrospective analysis of 200 stroke patients over a one-year period. The study will evaluate thiamine levels and look at cognitive function, length of stay, balance and other variables, breaking the population down by the predominant probable causes. These include diuretic use, diet, high alcohol intake, celiac disease and gastric bypass.
“The first step was finding that 10 percent were deficient in our preliminary review. If this holds true of the larger population, then we have a huge number of people with a condition that is easily missed but easily treatable,” Mansourian said.
Mansourian hopes to learn whether some deficient patients have been misdiagnosed with stroke, since the two conditions share multiple symptoms. His study will also shed light on whether stroke recovery is hindered by thiamine deficiency and helped by its restoration to normal levels.
“It is my mission to see patients checked for thiamine deficiency as they go into the hospital and at their physicians’ offices.”
Mansourian also hopes the study will highlight the value of testing for thiamine deficiency. “Ultimately, it is my mission to see patients checked for thiamine deficiency as they go into the hospital and at their physicians’ offices, so it becomes almost a standard, the way we check cholesterol levels.”
Mansourian is driven by a personal experience: “I began to focus on B1 deficiency when my father-in-law, a brilliant aerospace engineer, was reduced to a state of dementia from a thiamine deficiency that took one year to diagnose. He improved dramatically once he received thiamine, and it opened my eyes to other cases,” he said.