Who is Most Likely to Develop Thiamine Deficiency?

January 3, 2026 •

4 min read

Chronic alcohol use disorder is the most common cause of thiamine deficiency in industrialized nations, affecting up to 80% of those with chronic alcoholism. While rare in the general population with access to fortified foods, a thiamine deficiency can arise from various medical conditions, lifestyle choices, and dietary patterns that significantly impact intake, absorption, and utilization of this essential vitamin.

Quick Summary

This article identifies the populations most vulnerable to thiamine deficiency, including individuals with chronic alcoholism, malabsorption issues, post-bariatric surgery, malnutrition, and certain chronic diseases.

Key Points

Chronic Alcoholism: Up to 80% of those with alcohol use disorder develop thiamine deficiency due to poor nutrition and impaired absorption and storage of the vitamin.
Bariatric Surgery: Weight-loss procedures like gastric bypass lead to nutrient malabsorption, making supplementation crucial for preventing severe thiamine deficiency.
Malnutrition and Eating Disorders: Individuals with inadequate caloric or nutrient intake, including those with anorexia nervosa or subsisting on processed carbohydrates, are at high risk.
Chronic Illnesses and Medications: Patients with heart failure, HIV/AIDS, cancer, or those using diuretics or on dialysis often have depleted thiamine levels.
Specific Populations: The elderly, pregnant and lactating women, and breastfed infants of deficient mothers are also particularly vulnerable to thiamine deficiency.

Understanding Thiamine and Its Importance

Thiamine, or vitamin B1, is a water-soluble vitamin vital for converting food into energy, particularly for the nervous system, brain, and heart. Because the body stores only a small amount of it—enough for approximately 20 days—a regular dietary intake is necessary to prevent deficiency. A chronic shortage of thiamine can lead to serious conditions like beriberi and Wernicke-Korsakoff syndrome, which can cause heart failure, nerve damage, and memory impairment.

Primary Risk Factors for Thiamine Deficiency

Several groups face a significantly elevated risk of developing thiamine deficiency. These individuals may not consume enough thiamine, may have trouble absorbing it, or have increased metabolic demands that deplete their stores quickly.

Alcohol Use Disorder

In developed countries, chronic alcohol use is the leading cause of thiamine deficiency. Ethanol interferes with thiamine in multiple ways:

Decreased Intake: Individuals with alcohol use disorder often have poor nutritional habits, substituting food for alcohol, which results in low thiamine intake.
Impaired Absorption: Alcohol directly hinders the absorption of thiamine in the gastrointestinal tract.
Reduced Utilization and Storage: Chronic alcohol consumption reduces the liver's ability to store thiamine and impairs the conversion of thiamine to its active coenzyme form.

Bariatric Surgery and Malabsorption

Weight-loss procedures, particularly gastric bypass, are a major risk factor for deficiency due to the surgical alteration of the digestive tract. This limits the patient's caloric intake and interferes with nutrient absorption. Post-surgery, patients must follow strict dietary guidelines and often require lifelong micronutrient supplementation to prevent severe deficiency, including beriberi and Wernicke's encephalopathy. Conditions that cause chronic malabsorption, such as Crohn's disease, ulcerative colitis, and chronic diarrhea, also increase the risk.

Severe Malnutrition and Poor Diet

Insufficient dietary intake of thiamine-rich foods is a primary cause, especially in populations with low food security or those with specific eating patterns.

Refined Carbohydrates: Diets consisting predominantly of polished white rice, white flour, and refined sugar lack adequate thiamine because the vitamin is stripped away during processing.
Eating Disorders: Individuals with anorexia nervosa or other severe eating disorders are at high risk due to prolonged periods of restricted caloric intake and malnutrition.

Secondary and Contributing Risk Factors

Beyond the most common causes, other health conditions, medications, and life stages can make an individual more vulnerable.

Chronic Health Conditions

Diabetes: Studies have shown lower thiamine levels in individuals with type 1 and type 2 diabetes, potentially due to increased renal clearance of thiamine.
Heart Failure: Patients with chronic heart failure, often treated with diuretics, show high rates of thiamine deficiency.
HIV/AIDS and Cancer: Both conditions increase metabolic demands and are often associated with malnutrition, elevating the risk of deficiency.
Liver Disease: Impaired liver function can affect the metabolism and storage of thiamine.

Medical Interventions and Medications

Diuretic Therapy: Medications like furosemide, used to treat conditions such as heart failure and edema, can increase urinary thiamine loss.
Dialysis: Patients undergoing kidney dialysis, both peritoneal and hemodialysis, have an increased risk due to nutritional restrictions and the loss of water-soluble vitamins during treatment.
Refeeding Syndrome: Patients who are severely malnourished and are re-fed too quickly, especially with carbohydrates, can experience a sudden metabolic shift that increases thiamine consumption and triggers a deficiency.

Other Populations and Factors

Elderly Adults: Older individuals are at risk due to a combination of lower dietary intake, comorbidities, polypharmacy, and natural age-related decline in absorption.
Pregnancy and Lactation: Increased metabolic demand and hyperemesis gravidarum (severe vomiting during pregnancy) can lead to deficiency, which can also affect breastfed infants (infantile beriberi).
Dietary Antagonists: Excessive consumption of raw fish, shellfish, tea, or coffee, which contain thiaminases that destroy thiamine, can inhibit absorption.

A Comparison of High-Risk Factors


Risk Factor	Primary Mechanism	Associated Severe Conditions
Chronic Alcoholism	Decreased nutritional intake, impaired absorption and utilization, and reduced liver storage.	Wernicke-Korsakoff syndrome, wet or dry beriberi.
Bariatric Surgery	Surgically-induced malabsorption and limited intake of nutrients.	Wernicke's encephalopathy, beriberi.
Severe Malnutrition	Inadequate dietary intake of thiamine-rich foods.	Beriberi, growth retardation, impaired immunity.
Chronic Diuretic Use	Increased urinary excretion and depletion of water-soluble thiamine.	Heart failure exacerbation, peripheral neuropathy.
Elderly Adults	Poor dietary intake, chronic disease, medication use, and natural decline in absorption.	Neurological issues, cardiac problems.

Conclusion

While thiamine deficiency is rare in healthy individuals with access to fortified foods, certain populations are at a significantly higher risk due to compromised intake, absorption, or increased metabolic demand. The most susceptible groups include those with chronic alcohol use disorder, individuals who have undergone bariatric surgery, and people suffering from malnutrition due to eating disorders or poverty. Awareness of these risk factors is crucial for early detection and intervention, as timely treatment with thiamine supplementation can reverse many of the severe and potentially life-threatening symptoms of beriberi and Wernicke-Korsakoff syndrome. Seeking medical advice for symptoms like fatigue, irritability, and nerve problems is essential for prevention and management.

For more in-depth information on thiamine, including food sources and function, consult the National Institutes of Health (NIH) Office of Dietary Supplements fact sheet on the topic.(https://ods.od.nih.gov/factsheets/Thiamin-HealthProfessional/)

Frequently Asked Questions

The most common causes include chronic alcohol use disorder, malabsorption issues following bariatric surgery, severe malnutrition, and a diet high in processed carbohydrates like polished rice.

Alcohol can lead to thiamine deficiency by reducing dietary intake, impairing the absorption of thiamine in the gut, hindering the liver's ability to store the vitamin, and decreasing its overall utilization.

Yes, bariatric surgeries like gastric bypass alter the digestive system and limit food intake, significantly increasing the risk of thiamine malabsorption and subsequent deficiency.

Besides individuals with alcohol use disorder, other highly susceptible groups include patients with malabsorption syndromes, chronic diseases like HIV/AIDS and heart failure, the elderly, and pregnant or lactating women.

Certain medications, most notably loop diuretics such as furosemide, can increase urinary loss of thiamine, raising the risk of deficiency over time.

Infantile beriberi is a form of thiamine deficiency that affects infants, typically around 3-4 weeks old, who are exclusively breastfed by a mother who is thiamine deficient.

No, true thiamine deficiency is rare in developed countries due to widespread food fortification. However, specific at-risk populations with underlying medical conditions, such as those with alcohol use disorder or post-bariatric surgery, remain vulnerable.

Yes, diets centered around refined or polished carbohydrates, like white rice and sugar, lack sufficient thiamine, which is stripped during processing. This pattern of eating significantly contributes to deficiency.