What are the symptoms of thiamine deficiency?

Written by Brandon Okey. Mina Draskovic, B.Psy., reviewed this content for accuracy.

Thiamine deficiency occurs when your body doesn’t have enough vitamin B1 (thiamine). This nutrient is heavily involved in energy production and nerve function. A 2019 article reveals that the symptoms span from mild neurological and psychiatric to severe encephalopathy, heart failure, muscle atrophy, and even death.

Chronic drinking is one of the leading causes of thiamine deficiency because alcohol interferes with the body’s ability to absorb and use this vital nutrient. If alcohol addiction is starting to damage your health, at Ardu’s alcohol treatment program, you’ll find the support and care you need to stop drinking and turn your life around.

Why does your body need thiamine?

Thiamine, also known as vitamin B1, is an essential water-soluble nutrient and a key player in converting the food we eat into energy our cells can use.

Thiamine is one of the most important vitamins for your health because:

It acts as a coenzyme in several biochemical reactions, primarily in the metabolism of carbohydrates.
It contributes to the proper functioning of the pyruvate dehydrogenase complex, α-ketoglutarate dehydrogenase, and transketolase—enzymes critical for energy production and cellular functions.
It enables proper cell growth, development, and signaling. Every organ in your body relies on thiamine for cellular energy production.
It powers muscle contractions.
It facilitates connective tissue formation.
It conducts nerve signals throughout the body.
It synthesizes neurotransmitters that regulate mood, sleep, memory, and focus.
It maintains digestive health.
It bolsters immune function and response.
It regulates heart rhythm.

Low amounts of thiamine disrupt these delicate processes and lead to a cascade of metabolic problems that affect nearly all vital organ systems.

The body does not produce thiamine alone and can only store small amounts, so you need to keep getting it from your diet regularly. Vitamin B1 is found in whole grains, legumes, nuts, and fortified foods. However, certain factors can impair thiamine absorption or increase its excretion despite proper supplementation.

What is thiamine deficiency disorder?

Thiamine deficiency disorders (TDDs) encompass a range of medical conditions that result from inadequate levels of vitamin B1 in the body. These disorders include beriberi, which affects the cardiovascular system, and Wernicke-Korsakoff syndrome, which impacts the nervous system.

TDDs are clinical manifestations of thiamine deficiency. Someone can be thiamine deficient without immediately showing symptoms of a TDD, but as the deficiency progresses or becomes more severe, it leads to a spectrum of these disorders.

TDDs can affect anyone, but people with eating disorders, those who’ve had bariatric surgery, and individuals with HIV/AIDS are at higher risk. Pregnant and breastfeeding women also have increased thiamine needs and may be at risk if their diet is inadequate. TDD is common in parts of the world where polished rice is a dietary staple because the polishing process removes thiamine from white rice.

Thiamine deficiency produces diverse symptoms that often overlap with other conditions. Here are the main symptoms:

Neurological symptoms
Digestive symptoms
Cardiovascular symptoms
Psychiatric (emotional) symptoms
Other symptoms

What are the neurological manifestations of thiamine deficiency?

Thiamine deficiency manifests through neurological symptoms because vitamin B1 contributes to nerve function and brain health. The brain relies heavily on glucose metabolism, which requires thiamine, so a lack of this vitamin impacts neurological processes.

A 2021 study explains that thiamine deficiency disrupts energy metabolism in neurons, causing oxidative stress and impaired neurotransmission. This triggers neurological symptoms, from peripheral neuropathies to cognitive impairment and ataxia (loss of muscle coordination). In severe cases, a lack of vitamin B1 can cause structural changes in the brain, especially in areas with high metabolic demands.

The six key neurological manifestations of thiamine deficiency are:

Confusion: People may experience mental fog, disorientation, and difficulty thinking clearly. This ranges from mild forgetfulness to severe disorientation about time, place, or personal identity.
Ataxia: You might notice difficulty walking in a straight line, clumsiness, or trouble with fine motor skills.
Peripheral neuropathy: This involves damage to the nerves outside the brain and spinal cord. You might feel numbness, tingling, or burning sensations in your hands and feet. Over time, this can progress to muscle weakness and loss of sensation.
Memory problems: Short-term memory is often affected first. You might struggle to remember recent events or have trouble learning new information. In severe cases, long-term memory can also be impacted.
Ocular changes: Thiamine deficiency can affect eye function, causing involuntary or abnormal eye movements (nystagmus) or eye muscle paralysis. This may result in double vision or problems focusing, significantly impacting your visual perception and daily activities.
Seizures: Severe cases of thiamine deficiency may cause seizures These are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, or consciousness.

Proper diagnosis of thiamine deficiency is often delayed because TDDs are often overlooked or mistaken for other conditions. If left undiagnosed, thiamine deficiency can progress to severe neurological complications and may result in permanent brain damage or even death.

What are the gastrointestinal symptoms of thiamine deficiency?

Thiamine aids the production of hydrochloric acid in the stomach and the proper functioning of the smooth muscles in the gastrointestinal tract. Vitamin B1 is absorbed in the small intestine and transported throughout the body using specific carriers. Low levels of thiamine disrupt normal absorption and transport processes in the digestive system

Dhir, et. al. postulate that thiamine also plays a role in the metabolism of carbohydrates, so its deficiency affects the body’s ability to process and turn food into energy.

The most common gastrointestinal signs of thiamine deficiency include:

Loss of appetite (anorexia)
Nausea and vomiting
Abdominal pain or discomfort
Constipation
Reduced stomach acid production
Difficulty digesting carbohydrates
Unintentional weight loss

Many alcoholics struggle with malnutrition because alcohol not only depletes thiamine but also interferes with the absorption and metabolism of other essential nutrients. Ardu’s addiction treatment programs include nutritional therapy to restore the balance of vitamins and minerals and address the nutritional deficits caused by long-term alcohol abuse.

What are the cardiovascular signs you’re lacking vitamin B1?

Thiamine supports energy production in heart muscle cells and helps regulate heart rhythm through proper nerve function. Low thiamine levels impair the heart’s ability to generate energy efficiently. This condition, wet beriberi, severely affects heart function and blood circulation.

Thiamine deficiency has been suggested to be associated with many cardiovascular diseases (CVDs) and risk factors including type 1 and type 2 diabetes (T1D and T2D, respectively), obesity, chronic vascular inflammation, dyslipidemia, heart failure (HF), myocardial infarction (MI) and conduction defects, and depression. (Eshak and Arafa)

A group of American researchers posits that thiamine deficiency impairs ATP production, weakens heart muscle function, and leads to congestive heart failure. Over time, myocardial weakness worsens, which progresses to low-output heart failure and potential cardiovascular collapse.

Here are the main heart and blood vessel problems you might see if you’re low on thiamine:

Rapid heart rate (tachycardia)
Shortness of breath, especially during physical activity
Swelling in the lower legs and feet (edema)
Enlarged heart (cardiomegaly)
High-output heart failure
Chest pain or discomfort
Fatigue and weakness
Increased venous pressure
Difficulty breathing when lying down (orthopnea)
Irregular or rapid heartbeat (arrhythmias)

Emotional symptoms of thiamine deficiency

Thiamine deficiency can impact mental health and cognitive function. It has been linked to depression, anxiety, confusion, and memory problems in both adults and children. Since thiamine is essential for glucose metabolism in the brain, a deficiency can reduce the energy supply to brain cells, impair their function, and lead to emotional disturbances.

A 2019 study on neurological, psychiatric, and biochemical signs of vitamin B1 deficiency reveals more severe neurological conditions such as Wernicke-Korsakoff syndrome, which causes severe memory loss and cognitive impairment.

Zhang, et. al. propose that lower levels of thiamine in the blood were associated with a higher prevalence of depressive symptoms in older Chinese adults.

Here are the emotional symptoms caused by thiamine deficiency:

Irritability: Without enough thiamine, the brain struggles to maintain stable energy levels, which can lead to increased irritability as the nervous system becomes more sensitive to stress.
Anxiety: Thiamine helps regulate brain-calming neurotransmitters such as gamma-aminobutyric acid (GABA). A deficiency can lead to heightened anxiety as a result of an imbalance in calming and excitatory signals.
Depression: With reduced energy and neurotransmitter dysfunction, mood regulation can falter, leading to depressive symptoms. Thiamine is essential for serotonin and dopamine production, both critical for maintaining a positive mood.
Confusion and memory loss: Thiamine deficiency affects cognitive function by disrupting energy production in brain cells, leading to thinking difficulties, confusion, and memory issues.
Apathy: As brain function becomes impaired, motivation and interest in daily activities can decrease. Many people experience emotional detachment or apathy.

Addiction rarely travels alone. Many heavy drinkers find themselves battling depression, anxiety, or other mood disorders alongside their alcohol use disorder (AUD). It’s a vicious cycle—drinking depletes thiamine, worsening mental health, which can then drive more drinking.

Our dual diagnosis program tackles both substance abuse and mental health issues simultaneously to give you a real shot at lasting recovery. We don’t just patch up symptoms; we dig deep to address the root causes of your struggles by equipping you with the tools to build a healthier, more balanced life.

Contact Ardu Recovery Center and talk to our specialists about how to break free from addiction and rebuild your mental health.

Other symptoms of thiamine deficiency

Thiamine deficiency affects many parts of your body beyond just your brain, heart, gut, and emotions. Here are ten other ways low thiamine levels can show up in your body:

Muscle weakness: Your muscles may feel weak or tired, especially in your legs. This can make it hard to walk or climb stairs.
Swelling (edema): You might notice swelling in your legs, feet, or face. This happens because thiamine helps regulate fluid balance in your body, and low levels can lead to fluid retention.
Unexplained weight loss: You might lose weight without trying, even if you’re eating normally. This happens because thiamine helps your body process food.
Skin changes: Your skin might become dry, itchy, or take on a grayish color.
Fatigue: You might feel extremely tired all the time, regardless of how much you sleep.
Reduced reflexes: Your body’s natural reflexes, such as knee jerks, might become slower or less noticeable. This can affect your balance and coordination.
Sleep disturbances: You might have trouble falling asleep or staying asleep. Some people experience vivid nightmares or sleep paralysis.
Hearing loss: In some cases, thiamine deficiency causes hearing problems or ringing in the ears (tinnitus).
Peripheral neuropathy: You might feel tingling, numbness, or burning sensations in your hands and feet. This is a result of the nerve damage from lack of thiamine.
Hormonal imbalances: Low thiamine can affect your endocrine system, leading to issues such as irregular periods in women or decreased libido in both men and women.

Thiamine deficiency can quickly become a serious health issue if left unaddressed. If you recognize any of these signs in yourself or a loved one, don’t hesitate to seek medical help. Whether your low thiamine levels stem from diet, alcohol use, or other factors, get professional care right now.

What causes thiamine deficiency?

Many everyday factors can deplete your body’s thiamine reserves, often without you noticing—what you eat, certain medical treatments and even stress may lower thiamine levels.

According to the National Institutes of Health (NIH), low thiamine intake is most often associated with diets heavily reliant on polished rice or other low-thiamine staple foods. The study mentions that food processing, certain cooking methods, and consumption of thiamine antagonists contribute to reduced thiamine availability in the body.

Here are ten factors that lead to or contribute to thiamine depletion:

Poor diet or malnutrition: A diet lacking in thiamine-rich foods can quickly deplete your body’s stores. This often happens when people rely heavily on refined grains and don’t eat enough whole grains, legumes, and lean meats.
Excessive consumption of processed foods: Many processed foods are stripped of their natural thiamine content. A diet high in these foods means you’re likely not getting enough thiamine to meet your body’s needs.
Chronic illnesses: Certain long-term health conditions can interfere with thiamine absorption or increase your body’s demand for thiamine. Cancer, HIV/AIDS, and diabetes are examples of such conditions.
Eating disorders: People with anorexia or bulimia often don’t consume enough calories or nutrients, including thiamine. The frequent purging associated with bulimia can also lead to thiamine loss.
Bariatric surgery or other gastrointestinal surgeries: These procedures reduce your body’s ability to absorb thiamine from food.
Certain medications: Diuretics and some antibiotics may interfere with thiamine absorption or increase its elimination from the body.
Genetic disorders affecting thiamine absorption: Some people are born with conditions that make it hard for their bodies to absorb or use thiamine properly.
High-intensity physical activity: Athletes and people who engage in frequent, intense exercise have increased thiamine requirements. Their bodies use more energy, which demands more thiamine for metabolism. Without proper nutrition, these people may face thiamine deficiency.
Pregnancy and breast-feeding: Pregnancy and breastfeeding increase thiamine needs. Prolonged vomiting (such as severe morning sickness) rapidly depletes thiamine stores. These situations put women at higher risk of thiamine deficiency, which can also affect their babies.
Alcohol abuse: The NIH highlights that, while not primary, alcohol abuse is a major risk factor for thiamine deficiency, especially in countries with more diverse diets.

If your thiamine deficiency is related to alcohol use, Ardu’s alcohol detox center helps you safely manage withdrawal symptoms and address nutritional deficiencies. We strive to give you the best chance at a full recovery.

How does alcohol deplete thiamine?

Alcohol severely depletes thiamine levels. The more you drink, the faster your body loses vitamin B1. Martin, et. al. explain that heavy alcohol consumption disrupts how cells use thiamine for essential functions.

An article on alcohol-induced vitamin B1 deficiency investigates why chronic heavy drinkers often lack this essential nutrient.

Alcohol metabolism in the liver produces toxic byproducts that damage liver cells. Thiamine is necessary for energy production and detoxification, both of which are heavily involved in breaking down alcohol. Acetaldehyde, a toxic byproduct, harms liver cells and hinders the liver’s ability to properly activate thiamine.
Alcoholic metabolites trigger inflammation and oxidative stress which injure the mucosal epithelial cells responsible for nutrient uptake. The production of key intestinal thiamine transporters is disrupted, and the absorption of dietary thiamine is completely blocked.
Thiamine is not stored in the body long-term, but alcohol metabolism depletes its supplies even faster. Martel, et. al. estimate that thiamine’s half-life is 14 to 18 days. Regular intake is needed to maintain levels, and with chronic alcohol use, depletion outpaces replenishment.
Alcohol prompts cells to ramp up the production of thiamine efflux transporters—tiny pumps that push thiamine out of cells. Even when cells desperately need more thiamine to handle the stress from alcohol, they’re flushing out what little they have left. At the same time, cells need more thiamine for energy, but alcohol blocks its absorption from the gut, cutting off fresh supplies.
Alcoholics often have poor diets and they might go days without eating. When they do eat, it’s typically high in carbs and low in essential vitamins. High carbohydrate intake depletes thiamine even more because two enzymes essential for breaking down carbs depend on it to work.
Alcohol withdrawal rapidly depletes your body’s already low thiamine reserves. The stress of withdrawal increases your body’s demand for thiamine. At the same time, withdrawal symptoms such as vomiting and poor appetite make it hard to replenish thiamine through diet. This combination can quickly lead to a dangerous thiamine deficiency and may cause severe neurological problems.

Ardu Recovery Center addresses many of the root causes of thiamine deficiency, mainly those related to alcohol abuse and poor nutrition. Our comprehensive approach includes medical detox, nutritional therapy, and counseling to help you safely withdraw from alcohol, replenish vital nutrients such as thiamine, and develop healthier habits for long-term wellness.

What are the symptoms of B1 deficiency in infants?

Infantile thiamine deficiency, or infantile beriberi, is a serious condition that affects breastfed infants of thiamine-deficient mothers. It’s prevalent in regions with high polished rice consumption and areas with widespread alcohol abuse.

Breast milk is the primary thiamine source for infants, but its thiamine content directly reflects the mother’s nutritional status. Mothers may be unaware of their own thiamine deficiency because the symptoms can be subtle or mistaken for normal postpartum fatigue. Symptoms of infantile thiamine deficiency include:

Poor feeding and failure to thrive
Vomiting and diarrhea
Irritability and excessive crying
Tachypnea (rapid breathing)
Edema, particularly in the lower extremities
Cardiomegaly (enlarged heart)
Aphonia (loss of voice)
Seizures
Developmental delays
Altered muscle tone

Infants can lack thiamine while breastfed if their mothers are thiamine deficient. This often occurs as a result of:

Poor maternal diet
Increased maternal requirements
Certain medical conditions that impair thiamine absorption or increase its excretion
Cultural food practices
Lack of fortified foods
Alcohol abuse

Severe cases may progress to wet beriberi (affecting the heart) or encephalitic beriberi (impacting the brain). Both require immediate medical intervention.

How long does it take to recover from thiamine deficiency?

Recovering from thiamine deficiency takes time, and the duration is different for each person. Those with mild deficiency may feel better within days of starting supplements while thiamine-deficient people, especially if it has affected their nervous system, may need weeks or months to see significant improvement.

For thiamine deficiency caused by alcohol abuse, recovery involves both thiamine supplementation and stopping alcohol consumption. While some symptoms may improve quickly, full recovery often requires several months.

Unfortunately, severe thiamine deficiency can cause permanent damage in some cases. Early treatment can prevent further harm and improve existing symptoms. Even after initial recovery, most people need to continue taking supplements and maintain a thiamine-rich diet to prevent the deficiency from recurring.

Reach out to Ardu for comprehensive treatment

At Ardu, we understand that overcoming alcohol addiction requires more than just treatment—it’s about restoring health, vitality, and emotional well-being. Our drug and alcohol rehab center guides you through every stage of recovery, from detox to long-term sobriety, while addressing your physical, emotional, and mental health.

Your journey begins with a medically supervised detox, where we help safely remove alcohol from your system. We also offer holistic detox options that promote overall well-being by addressing both the body and mind. After detox, you’ll transition into rehab, where you’ll have access to individual and group therapy sessions tailored to treat alcohol addiction.

We offer a range of therapies that not only focus on overcoming addiction but also on revitalizing your health. Some of these include:

Cognitive behavioral therapy (CBT): This evidence-based therapy helps you identify and change negative thought patterns and behaviors related to addiction. It improves mental health and decision-making.
Dialectical behavioral therapy (DBT): DBT focuses on emotional regulation and stress management, equipping you with tools to handle cravings and reduce the risk of relapse.
Holistic rehab therapies: We incorporate holistic treatments such as yoga, meditation, and nutritional support, all of which promote physical healing, restore energy levels, and enhance mental clarity.
IV therapy: For those struggling with severe nutrient depletion, we offer IV amino acid therapy to quickly restore essential nutrients such as thiamine and other B vitamins.
Physical therapy and exercise programs: Rebuilding strength and stamina is key to a full recovery. Our exercise programs help restore physical health, boost mood, and improve overall vitality.

Ardu’s compassionate and experienced team is here to walk with you every step of the way. Whether you choose our residential treatment facilities or outpatient programs, we are committed to helping you achieve lasting recovery and restored well-being.

Contact Ardu today to discuss your unique needs and start your journey toward health and freedom from alcohol addiction.

Brandon Okey is the co-founder of Ardu Recovery Center and is dedicated to empowering people on their journey to sobriety.

Thiamine deficiency FAQ

Does coffee deplete B1?

Coffee contains tannins, which are anti-thiamine compounds that bind to thiamine and block its absorption. Chronic coffee consumption can reduce thiamine levels, increasing the risk of thiamine deficiency. The risk of deficiency is higher in individuals with poor dietary intake or alcohol use disorder because they further deplete thiamine stores.

Health care providers recommend limiting excessive coffee intake to avoid aggravating thiamine deficiency, which can lead to dry beriberi, cardiovascular beriberi, and neurological issues such as Wernicke-Korsakoff syndrome.

What mimics thiamine deficiency?

Several conditions mimic thiamine deficiency because of overlapping symptoms:

Alcohol use disorder: Alcohol inhibits thiamine absorption, leading to neurological and cardiovascular symptoms similar to those caused by thiamine deficiency.
Magnesium deficiency: This can cause muscle cramps, fatigue, and neurological symptoms.
Diabetic neuropathy: The nerve damage caused by diabetes mimics dry beriberi.
Chronic fatigue syndrome: Persistent fatigue and cognitive impairment are similar to those caused by thiamine deficiency.
Hypothyroidism: Fatigue and mental fog from hypothyroidism resemble symptoms of low thiamine.

What are the symptoms of too much vitamin B1?

Excess thiamine from supplements is rare since thiamine is water-soluble, meaning any excess is excreted through urine. If you do take very high doses of parenteral thiamine or oral thiamine supplements (above 500 mg per day), you may experience mild side effects such as:

Nausea
Dizziness
Rapid heartbeat
Sweating
Abdominal discomfort

While these effects are uncommon, follow appropriate dosage recommendations. Administration of thiamine should always follow healthcare provider guidelines to avoid any potential risks.

Can too much thiamine cause anxiety?

Excessive thiamine intake is not typically linked to anxiety. Thiamine deficiency, rather than excess, is associated with mood disorders such as anxiety, depression, and irritability. Thiamine is necessary for neurotransmitter production, so proper levels regulate mental status.

In rare cases, high doses of thiamine from supplements might cause overstimulation or restlessness, but these instances are uncommon. For people with alcohol use disorder or poor dietary intake, supplementing with thiamine can reduce symptoms of anxiety, especially if deficiency-related.

How much B1 is safe per day?

The recommended daily intake of thiamine varies by age and life stage:

1.1 mg/day for adult women
1.2 mg/day for adult men
1.4 mg/day for pregnant or breastfeeding women

Higher doses are safe when treating thiamine deficiency, with up to 100 mg/day commonly prescribed. In severe cases, such as Wernicke-Korsakoff syndrome or cardiac beriberi, parenteral thiamine doses of 100–500 mg may be given by health care providers.

Why is thiamine given to infants?

Thiamine is given to infants to prevent or treat thiamine deficiency disease. In clinical settings, doctors may administer thiamine when infants show signs of poor intake or chronic deficiency. This is especially important for breastfed infants whose mothers have low dietary thiamine intakes. Thiamine supplementation can rapidly improve symptoms and prevent serious complications like beriberi. In some cases, pharmacological doses quickly restore thiamine levels.

For infants with severe deficiency or those at high risk, thiamine replacement therapy is prescribed. It involves administering thiamine to quickly restore adequate levels in the body, while infant formula is fortified with thiamine. This therapy is needed for proper brain development, mitochondrial functions, and overall growth in infants. Without sufficient thiamine, infants may experience developmental delays, neurological problems, and impaired energy metabolism at the cellular level.

At what age are the infants affected with infantile beriberi?

Infantile beriberi typically affects infants between 2 and 6 months of age. The risk of deficiency can start from birth, especially in areas with a high prevalence of thiamine deficiency among pregnant women. A retrospective study of Cambodian infants showed cases as early as 3 weeks old.

The onset can vary based on maternal thiamine intake during pregnancy and postpartum. Breastfed infants are particularly vulnerable if maternal thiamine status is poor. Early diagnosis relies on recognizing clinical symptoms and sometimes erythrocyte transketolase activity measurements.

What is the difference between wet and dry beriberi?

Wet and dry beriberi are two types of beriberi caused by thiamine deficiency:

Wet beriberi: Primarily affects the cardiovascular system, leading to fluid retention, heart failure, and edema (swelling). Wet beriberi can result in cardiac dysfunction, including enlarged ventricles and weakened heart muscles.
Dry beriberi: Affects the nervous system, causing peripheral neuropathy, muscle weakness, and loss of coordination. Symptoms include difficulty walking, numbness, and muscle atrophy.

Both types can be treated with thiamine supplements, and in severe cases, parenteral thiamine administration is needed to address the condition.

What are the five signs of Korsakoff’s syndrome?

Korsakoff’s syndrome, often linked to chronic thiamine deficiency and alcohol use disorder, presents with the following signs:

Severe memory loss: Inability to recall recent events.
Confabulation: Making up stories to fill memory gaps.
Disorientation: Confusion about time and place.
Apathy: Lack of interest or emotional engagement.
Inability to form new memories: Difficulty learning or retaining new information.

Wernicke-Korsakoff syndrome is a result of prolonged thiamine deficiency, often seen in alcohol use disorder patients with poor dietary intake. Treatment with high doses of parenteral thiamine can improve symptoms if administered promptly.

Why do alcoholics need folic acid?

Alcoholics need folic acid because alcohol inhibits the absorption of this vital nutrient, leading to folate deficiency. Folic acid is needed for DNA synthesis, cell division, and red blood cell production. Alcoholics are at a higher risk for thiamine deficiency because of poor dietary intake and damage to the digestive system caused by alcohol. Deficiency can result in anemia, fatigue, and cognitive impairments, similar to those seen in thiamine deficiency.

Resources

Dhir, S., Tarasenko, M., Napoli, E., & Giulivi, C. (2019). Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults. Frontiers in Psychiatry, 10, 447129. https://doi.org/10.3389/fpsyt.2019.00207

Smith, T. J., Johnson, C. R., Koshy, R., Hess, S. Y., Qureshi, U. A., Mynak, M. L., & Fischer, P. R. (2021). Thiamine deficiency disorders: A clinical perspective. Annals of the New York Academy of Sciences, 1498(1), 9-28. https://doi.org/10.1111/nyas.14536

Eshak, E., & Arafa, A. (2018). Thiamine deficiency and cardiovascular disorders. Nutrition, Metabolism and Cardiovascular Diseases, 28(10), 965-972. https://doi.org/10.1016/j.numecd.2018.06.013

Helali, J., Park, S., Ziaeian, B., Han, J. K., & Lankarani-Fard, A. (2019). Thiamine and Heart Failure: Challenging Cases of Modern-Day Cardiac Beriberi. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 3(2), 221-225. https://doi.org/10.1016/j.mayocpiqo.2019.03.003

Zhang, G., Ding, H., Chen, H., Ye, X., Li, H., Lin, X., & Ke, Z. (2012). Thiamine Nutritional Status and Depressive Symptoms Are Inversely Associated among Older Chinese Adults. The Journal of Nutrition, 143(1), 53-58. https://doi.org/10.3945/jn.112.167007

Whitfield, K. C., Bourassa, M. W., Adamolekun, B., Bergeron, G., Bettendorff, L., Brown, K. H., Cox, L., Fischer, P. R., Frank, E. L., Hiffler, L., Hlaing, L. M., Jefferds, M. E., Kapner, H., Kounnavong, S., Mousavi, P. S., Roth, D. E., Tsaloglou, N., & Wieringa, F. (2018). Thiamine deficiency disorders: Diagnosis, prevalence, and a roadmap for global control programs. Annals of the New York Academy of Sciences, 1430(1), 3-43. https://doi.org/10.1111/nyas.13919

Martin, P. R., Singleton, C. K., & Hiller-Sturmhöfel, S. (2003). The Role of Thiamine Deficiency in Alcoholic Brain Disease. Alcohol Research & Health, 27(2), 134-142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668887/

Langlais, P. J. (1995). Alcohol-Related Thiamine Deficiency: Impact on Cognitive and Memory Functioning. Alcohol Health and Research World, 19(2), 113-121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875731/

Martel, J. L., Kerndt, C. C., Doshi, H., Sina, R. E., & Franklin, D. S. (2024, January 31). Vitamin B1 (Thiamine). StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482360/

Whitfield, K. C., Smith, G., Chamnan, C., Karakochuk, C. D., Sophonneary, P., Kuong, K., Dijkhuizen, M. A., Hong, R., Berger, J., Green, T. J., & Wieringa, F. T. (2017). High prevalence of thiamine (vitamin B1) deficiency in early childhood among a nationally representative sample of Cambodian women of childbearing age and their children. PLoS Neglected Tropical Diseases, 11(9). https://doi.org/10.1371/journal.pntd.0005814