Who gets thiamine deficiency? An overview of risk factors

October 19, 2025 •

4 min read

According to the National Institutes of Health, chronic alcohol use is the most common cause of thiamine deficiency in industrialized nations, affecting up to 80% of individuals with chronic alcoholism. This deficiency, also known as beriberi, is not limited to alcoholism, and understanding who gets thiamine deficiency is crucial for early detection and prevention.

Quick Summary

Thiamine deficiency disproportionately affects individuals with chronic alcoholism due to poor intake and impaired absorption. Malnutrition, chronic diseases, bariatric surgery, and certain dietary habits also increase the risk. Populations in food-insecure regions and breastfed infants of deficient mothers are also susceptible.

Key Points

Alcohol Use: Chronic alcoholism is a major cause of thiamine deficiency, impairing absorption, storage, and utilization of the vitamin.
Malnutrition: A diet predominantly of refined grains or severe undernourishment (e.g., from anorexia) can deplete thiamine reserves within weeks.
Medical Conditions: Chronic illnesses like Crohn's disease, hyperthyroidism, and kidney disease can affect thiamine absorption and increase metabolic demand.
Surgical Patients: Individuals who have undergone bariatric surgery are at high risk due to decreased food intake and nutrient malabsorption.
Infants and Mothers: Infants exclusively breastfed by a thiamine-deficient mother are at risk of infantile beriberi, which can be fatal if untreated.
Long-term Diuretic Use: Patients on certain diuretics for conditions like heart failure can experience increased urinary excretion of thiamine.
Vulnerable Populations: People in food-insecure regions, refugees, and those following restrictive diets are highly susceptible to developing thiamine deficiency.

Demographics and Lifestyle Factors

While thiamine deficiency is rare in countries with fortified foods, certain populations and lifestyle choices dramatically increase risk. The most prominent factor in developed nations is chronic alcohol use, which impairs thiamine absorption and storage. In contrast, in regions with food insecurity, dependence on highly processed carbohydrates like polished white rice is a major driver of deficiency.

Alcohol Use Disorder

Chronic and excessive alcohol consumption is a primary risk factor for thiamine deficiency globally. The reasons for this are multi-layered and include:

Poor nutritional intake: Heavy drinkers often substitute alcohol for food, resulting in an inadequate diet low in essential vitamins.
Impaired absorption: Alcohol damages the lining of the gastrointestinal tract, hindering the absorption of thiamine into the bloodstream.
Decreased liver storage: Liver damage from chronic alcohol use impairs the organ's ability to store thiamine.
Impaired utilization: Chronic alcohol consumption can lead to magnesium deficiency, which is essential for activating thiamine in the body.

Malnutrition and Dietary Habits

Malnutrition is a significant contributor to thiamine deficiency, particularly in vulnerable populations and those with eating disorders.

Undernourishment and starvation: Conditions of severe undernourishment or starvation can deplete the body's limited thiamine stores within weeks, leading to deficiency.
Refeeding syndrome: Patients who have been malnourished and are then refed aggressively can develop thiamine deficiency as the reintroduction of carbohydrates increases the body's need for the vitamin.
Diets high in processed carbohydrates: In many parts of the world, populations rely heavily on polished white rice or other refined grains, which are low in thiamine. Fortification is critical in these areas to prevent large-scale outbreaks of beriberi.

Medical Conditions and Surgical Procedures

A range of health issues and medical treatments can disrupt the body's thiamine balance, even with a seemingly healthy diet.

Bariatric Surgery

Weight loss surgeries, such as gastric bypass, are a known risk factor for thiamine deficiency due to a combination of decreased food intake and reduced nutrient absorption. Post-surgical patients require lifelong supplementation and monitoring to prevent deficiencies.

Chronic Gastrointestinal Diseases

Conditions that cause chronic diarrhea or inflammation of the digestive tract interfere with thiamine absorption.

Crohn's disease: Inflammation from this condition can limit nutrient uptake.
Celiac disease: Intestinal damage from gluten exposure can lead to malabsorption.
Hyperemesis gravidarum: Severe, persistent vomiting during pregnancy can lead to inadequate nutrient intake and depletion of thiamine stores.

Other Chronic Illnesses

Various chronic conditions can also increase the body's demand for thiamine or interfere with its metabolism.

Hyperthyroidism: An overactive thyroid increases the body's metabolic rate, which raises the need for thiamine.
Kidney disease and dialysis: Patients undergoing dialysis can lose thiamine during the procedure, requiring supplementation.
Heart failure: Chronic use of diuretics to treat heart failure can increase urinary excretion of thiamine.

Table: Thiamine Deficiency Risk Factors and Contributing Mechanisms


Risk Factor	Primary Mechanism	Specific Considerations
Alcohol Use Disorder	Decreased intake, reduced absorption, impaired utilization, decreased liver storage	Wernicke-Korsakoff syndrome is a severe neurological complication
Malnutrition/Starvation	Inadequate dietary intake of thiamine	Seen in eating disorders, food-insecure populations, and during famine
Bariatric Surgery	Decreased food intake and malabsorption post-surgery	Lifelong monitoring and supplementation are necessary to prevent recurrence
Chronic GI Diseases	Impaired absorption due to inflammation and chronic diarrhea	Includes Crohn's disease, celiac disease, and hyperemesis gravidarum
Diuretic Use (Heart Failure)	Increased urinary excretion of thiamine	Especially prevalent with long-term use of certain loop diuretics
Infancy (Breastfeeding)	Inadequate maternal thiamine intake passed through breastmilk	Rapid onset and potentially fatal cardiac or neurological symptoms in infants
Chronic Kidney Disease	Loss of thiamine through frequent dialysis treatments	Replacement therapy is essential for patients on long-term dialysis

Infants and Pregnant/Lactating Women

Infantile beriberi is a particularly severe and rapid form of thiamine deficiency that affects infants breastfed by mothers with low thiamine levels. The mother's thiamine status is directly linked to the thiamine content of her breastmilk. Outbreaks have been documented in populations with restricted diets, especially in cultures with postpartum food restrictions or reliance on polished rice. Symptoms in infants can include sudden heart failure, loss of voice, and absent reflexes. In addition to pregnancy and breastfeeding, which increase the body's thiamine needs, conditions like hyperemesis gravidarum (severe morning sickness) can lead to a deficiency.

Conclusion

While relatively uncommon in developed countries with a steady supply of fortified foods, thiamine deficiency remains a serious health concern for many high-risk individuals. The primary groups at risk include those with chronic alcohol use disorder, people experiencing malnutrition or eating disorders, and patients who have undergone bariatric surgery. Chronic illnesses affecting absorption or increasing metabolic demand, such as heart and kidney disease, also play a significant role. Early recognition of these risk factors is crucial, as is prompt treatment with thiamine supplements, which can reverse symptoms and prevent long-term, irreversible damage, particularly to the nervous system and heart. Raising awareness among both patients and healthcare providers is key to saving lives and improving outcomes. For further details on thiamine's role, sources, and treatment, see the Health Professional Fact Sheet from the National Institutes of Health.

Frequently Asked Questions

In developed nations, the most common cause of thiamine deficiency is chronic alcoholism. Alcohol reduces thiamine absorption and liver storage while also contributing to poor dietary intake.

Bariatric surgery increases the risk of thiamine deficiency by limiting both food intake and the body's ability to absorb nutrients due to changes in the digestive tract. Patients often require long-term supplementation.

Yes, a diet consisting mainly of highly processed, refined carbohydrates, such as polished white rice, can cause a thiamine deficiency. This is a common issue in food-insecure regions where dietary diversity is limited.

Infantile beriberi is a severe form of thiamine deficiency that affects infants breastfed by mothers with inadequate thiamine intake. It can lead to sudden heart failure, neurological problems, and death.

Certain diuretics, particularly those used long-term for conditions like heart failure, can increase the excretion of thiamine through the urine, depleting the body's stores over time.

Chronic illnesses, including HIV/AIDS, hyperthyroidism, and kidney disease, can increase the body's metabolic demand for thiamine or impair its absorption and utilization, leading to a deficiency.

No, thiamine deficiency is not always a dietary problem. While low intake is a cause, impaired absorption, increased metabolic demand, and excessive excretion due to medical conditions, alcohol use, or medication can also cause it.