Colin MacKenzie M.D.
October 20, 2020

During the treatment of alcohol withdrawal, it is often necessary to replenish vitamins in those with alcohol use disorders.  In this article, we will discuss a vitamin called thiamine which is a critical component of every alcohol withdrawal treatment regimen. 

What is thiamine? 

Thiamine, or vitamin B1, is a co-factor or “helper” molecule for many different enzymes in the body responsible for the catabolism of various amino acids, carbohydrates, and lipids.  For those who are interested, these enzymes are:

Enzyme model with substrate molecule and thiamine © TelePsychiatry Associates, LLC 
  • pyruvate dehydrogenase and 2-oxoglutarate dehydrogenase (also called alpha-ketoglutarate dehydrogenase)
  • branched-chain alpha-keto acid dehydrogenase
  • 2-hydroxyphytanoyl-CoA lyase
  • transketolase

Thiamine is necessary for the proper function of these metabolic enzymes.  These enzymes are needed to derive energy from the food we eat (Don’t make the false assumption that taking more thiamine will “give” you more energy. It doesn’t work that way).  Thiamine is also critical for proper neuron cell integrity and function.  All organisms use thiamine, but only certain bacteria, fungi, and plants can actually manufacture the molecule thus making it necessary for us to obtain it through our diets.  Thiamine is found most plentifully in fish, legumes, meats, and whole grains. 

The body contains about 30mg of thiamine, which has a half-life in the body of about 18 days. Thus, if you were to stop your intake of thiamine, your body would be deficient in about 12 weeks.  Those parts of the brain with high metabolic activity are particularly sensitive to thiamine deficiency because they require significant amounts of thiamine to maintain the energy needs of these neurons.  When these “high energy” neurons no longer have enough thiamine, they cannot maintain normal biochemical processes such as maintaining ion concentrations across the phospholipid bilayer of the neuron causing it to breakdown.  This causes “cellular stress” which leads to reactions that cause cell death (apoptosis). 

How does alcoholism impact thiamine in the body? 

Many people who struggle with alcoholism maintain a poor diet, sometimes relying solely on alcoholic beverages for their caloric needs, and do not ingest enough thiamine to meet requirements.  In addition, alcohol can cause a chronic inflammation of the lining of the stomach and intestines making it difficult for the body to absorb necessary nutrients including thiamine.  Alcohol also directly impairs the function of thiamine, impairs its conversion into its active form, and impairs its storage in the liver.  Over time, this can lead to thiamine deficiency (relative and absolute) and a condition called Wernicke’s Encephalopathy (W.E.).  A triad of symptoms including difficulty with balance, visual disturbance, and confusion characterizes W.E.  Administration of thiamine can prevent these symptoms and can even reverse current symptoms if given early. 

At My Home Detox (A division of TelePsychiatry Associates), all individuals are started on thiamine at the proper doses and frequency before alcohol detox begins to prevent the consequences of thiamine deficiency. 


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