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U.S. Doctors Behind Curve on Thiamine Use in Alcoholics

Posted in Alcoholism Treatment

Thiamine is an alternative name for vitamin B1, a substance essential for maintaining normal human health and wellbeing. People affected by alcohol use disorder (alcoholism and alcohol abuse) can develop significant deficiencies of this vitamin; in turn, an alcohol-related thiamine deficiency can lead to the onset of severe brain damage. Doctors in certain areas outside the U.S. commonly use thiamine supplementation as part of standard treatment for alcohol use disorder. However, despite this fact, the results of a study published in January 2014 in the Journal of Addiction Medicine indicate that American doctors don’t typically know enough to use such supplementation effectively.

The Basics

The human body relies on the B vitamin family to do a number of critically important things, including supporting the healthy function of various organ systems and enabling efficient processing of the energy contained in food and beverages. Thiamine, in particular, plays a critical role in the body’s ability to access the energy contained in carbohydrates, maintain healthy muscle tissue and maintain healthy nerve tissue. Commonly available sources of this vitamin in the average well-rounded diet include various nuts and seeds, legumes, pork, eggs, beef liver and whole grain products, as well as fortified or enriched non-whole grain products and (to a lesser extent) vegetables, fruits and dairy. Most people in the U.S. get enough dietary thiamine to meet their general needs.

Thiamine Deficiency and Alcohol Consumption

A thiamine deficiency can appear in someone who doesn’t get enough of the vitamin in his or her regular diet, or in someone whose body can’t properly use the vitamin when it’s consumed. In the U.S., most people affected by such a deficiency drink too much and qualify for an alcohol use disorder diagnosis. Thiamine deficiencies develop in heavy drinkers for two reasons. First, consumption of large amounts of alcohol can reduce the body’s natural ability to absorb and use the vitamin. In addition, alcoholics in particular may not regularly eat enough food, or eat a wide enough variety of foods, to ensure that their diets contain adequate amounts of thiamine.

Two forms of serious brain damage are associated with alcohol-related thiamine deficiencies: Wernicke’s disease (Wernicke’s encephalopathy) and Korsakoff syndrome (sometimes referred to together as Wernicke-Korsakoff syndrome). People with Wernicke’s encephalopathy can develop potentially reversible symptoms that include loss of leg muscle control, a lack of mental clarity, vision or eyelid dysfunction and life-threatening versions of the problems normally found in individuals going through alcohol withdrawal. Korsakoff syndrome is a form of psychosis (the common term for the combination of hallucinations and delusional thinking) related to permanent alteration of the brain’s ability to make or process memories. The vast majority of people who develop Wernicke’s encephalopathy also develop Korsakoff syndrome.

Effectiveness of Supplementation

Doctors throughout Europe commonly rely on thiamine supplementation to help their patients affected by alcohol use disorder avoid the onset of Wernicke-Korsakoff syndrome. The vitamin doses used for this purpose typically far exceed the doses used in other populations affected by a thiamine deficiency. Despite these facts, current evidence indicates that U.S. doctors and researchers know relatively little about thiamine supplementation. In the study published in the Journal of Addiction Medicine, a team of American researchers used the daily operations in a single teaching hospital to gauge the effectiveness of alcohol use disorder-related thiamine supplementation in this country. All told, the study included 217 individuals affected by alcohol use disorder. Some of these individuals had received supplemental thiamine as part of their treatment, while others had not.

The researchers concluded that, even when the patients involved in the study received supplemental thiamine as part of their treatment regimen, the doses prescribed were typically quite low and in line with general supplementation guidelines, not the guidelines used in Europe to treat those affected by alcohol use disorder. This pattern of low dosage existed even among those individuals identified as being high-risk candidates for the onset of Wernicke-Korsakoff syndrome. In addition, while doctors in Europe typically deliver thiamine to their alcohol use disorder-affected patients intravenously or through other rapidly effective methods, the U.S. doctors in the study typically delivered thiamine to their patients through relatively slow-acting oral supplementation. 

Significance and Considerations

The authors of the study published in the Journal of Addiction Medicine believe they are the first U.S. researchers to ever study how thiamine is used in an American hospital as part of alcohol use disorder-related treatment. Based on their findings, they concluded that the U.S. medical establishment must substantially improve its working knowledge of Wernicke-Korsakoff syndrome, as well as its understanding of the usefulness of high-dose thiamine supplementation as an effective preventative treatment. No one should ever take thiamine supplements without advice and supervision from a qualified physician.