What is vitamin B1 (thiamine)?

Thiamine, which is also known as vitamin B1, is an essential micronutrient, which is required for metabolism, enzymatic processes and conduction of nerve signals. All living organisms use thiamine, but it can be made only in bacteria, fungi and plants. In humans, gastrointestinal microbiota also produces thiamine, but not enough for the organism functioning. Thus, we, as well as other animals must obtain vitamin B1 from the diet.

Thiamine deficiency

Deficiency of thiamine can affect the cardiovascular, nervous and immune systems. A severe and chronic form is known as beriberi. Wet beriberi affects cardiovascular system resulting in tachycardia, high arterial and venous pressures, leg swelling. Dry beriberi affects nervous system resulting in impairment of sensory, motor and reflex functions and altered mental status. Worldwide thiamine deficiency is most widely reported in populations where primary food source are polished rice and grains. In Western countries, it most commonly affects people suffering from alcoholism or chronic illness. Thiamine deficiency in patients with alcohol use disorder often lead to Kosakoff syndrome, a chronic disease with severe memory loss and learning problems.

Food sources of thiamine

It is very easy to add foods rich with thiamine to the diet. Food sources of thiamine include beef, pork, eggs, liver, nuts, oats, oranges, seeds, legumes and yeast. Such foods as rice, pasta, breads, cereals and flour are often fortified with vitamin B1 as the processing involved in creating these products removes thiamine. Thiamine supplements and medications are available on market to treat or prevent thiamine deficiency. Remarkably, B1 is well tolerated and has almost no side effects.

Bioavailable analogues of Thiamine

Analogues of vitamin B1, such as benfotiamine or dibenzoyl thiamine, have improved bioavailability, due to their higher lipid solubility, which facilitate permeation in cell membranes. As a result, they provide higher levels of thiamine in muscle, brain and liver. This can be the reason of their higher effectiveness.

Thiamine as medication

Thiamine was the first of the water-soluble vitamins to be discovered, and since early 20th century it was extensively studied. Most commonly thiamine supplementation is used to treat syndromes associated with severe thiamine deficiency and during pregnancy and lactating due to increased need for this vitamin. Rapid recovery can occur within hours if thiamine is given intravenously. If concentrated thiamine supplements are not available, diets rich with thiamine will also lead to recovery, though at a slower rate.

New properties of thiamine

Recently, other important roles of thiamine including the regulation of oxidative stress were discovered [1]. As emotional stress is associated with oxidative stress in the brain, it was hypothesized that thiamine can counteract negative effects of the stress. And indeed, in studies on mice thiamine precluded negative changes in mood and emotionality, as well as neuroinflammation and oxidative stress caused by stress [2,3]. It also ameliorated cellular proliferation and neurogenesis in the hippocampus under stress conditions. In agreement with animal studies, vitamin B1 was also able to ameliorate symptoms of major depressive disorder in patients [4] or work stress-related mood swings [5].

Thus, thiamine was shown as a promising treatment for the depressive-like changes and excessive aggression, caused by stress. Hopefully, new studies on thiamine will be conducted in the nearest future to show novel properties of this vitamin.

 

References

[1]      L. Bettendorff, P. Wins, Biological functions of thiamine derivatives: Focus on non-coenzyme roles, OA Biochem. 1 (2013).

[2]      N. Markova, N. Bazhenova, D.C. Anthony, J. Vignisse, A. Svistunov, K.-P. Lesch, L. Bettendorff, T. Strekalova, Thiamine and benfotiamine improve cognition and ameliorate GSK-3β-associated stress-induced behaviours in mice, Prog. Neuro-Psychopharmacology Biol. Psychiatry. 75 (2017) 148–156.

[3]      A. Gorlova, D. Pavlov, D.C. Anthony, E.D. Ponomarev, M. Sambon, A. Proshin, I. Shafarevich, D. Babaevskaya, K.-P. Lesсh, L. Bettendorff, T. Strekalova, Thiamine and benfotiamine counteract ultrasound-induced aggression, normalize AMPA receptor expression and plasticity markers, and reduce oxidative stress in mice, Neuropharmacology. (2019).

[4]      A. Ghaleiha, H. Davari, L. Jahangard, M. Haghighi, M. Ahmadpanah, M.A. Seifrabie, H. Bajoghli, E. Holsboer-Trachsler, S. Brand, Adjuvant thiamine improved standard treatment in patients with major depressive disorder: results from a randomized, double-blind, and placebo-controlled clinical trial, Eur. Arch. Psychiatry Clin. Neurosci. 266 (2016) 695–702.

[5]      C. Stough, A. Scholey, J. Lloyd, J. Spong, S. Myers, L.A. Downey, The effect of 90 day administration of a high dose vitamin B-complex on work stress, Hum. Psychopharmacol. Clin. Exp. 26 (2011) 470–476.

 

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When going to a doctor, you mostly aim for two things to happen: one, you want the doctor to tell you what kind of disorder you are currently suffering from and two, you hope for him or her to give you adequate treatment. While most people are able to follow their physician’s instructions well enough when they have to take medication like antibiotics for a few days, the longer the therapy needs to be, the less likely they are to “adhere”.

Adherence is a term to describe to what extent a person’s behavior in taking medication corresponds with agreed recommendations from a healthcare provider1. This means that after a physician has informed you about possible treatment options, you decide together what kind of treatment you are going to receive². Afterwards, if you stop taking the medication or choose not to take some of it, your behavior might be classified as non-adherent. Said non-adherence has significant impact on treatment effectiveness, individual suffering and health care costs³. If prescribed medication is secretly not taken, doctors might increase doses or switch to different substances as they suspect the current drug is not working properly.

A recent study explored adolescents’ health beliefs and subjective opinions relating to psychotropic medication, and statistically linked them to reported medication adherence. Adolescents age 12-17 answered a series of interview questions regarding their personal perceptions of their own course of disease, experienced symptoms and physician–patient relationship. Additionally they reported on their individual appraisal of positive effects from psychotherapy and/or medication, thoughts on adverse events, and thoughts on disease-related interactions with their friends and families.

Authors found that patients classified as non-adherent could be characterized as more likely to report feeling worse after taking medication, to describe a lower sense of self-efficacy concerning the improvement of their symptoms, and/or to perceive a less trustful physician–patient relationship. Furthermore, non-adherent patients were more likely to state that their attitude toward medication worsened after experiencing “side effects”, that they subjectively felt less support from their relatives, and/or they had fewer individuals in their family who were fully informed about their condition4.

In summary, if the medication you are taking is making you feel worse than you did before, if you feel like you have little or no control over your own symptoms, if you distrust your physician or if you feel your family isn’t supporting you (enough), this might lead you to stop your medication – possibly without telling your physician about it.

What can we learn from these results?

Health care providers can learn how important it is to repeatedly talk to their patients about their feelings towards the medication and encourage them to speak openly about medication-related doubts or worries. They can also learn how important their interaction with patients is, as even the best drug can’t work properly if it isn’t taken.

As a patient, one might realize that not wanting to take prescribed medication is a common occurrence, and one shouldn’t feel embarrassed or guilty about it. What is important, though, is to openly talk to the treating physician about it and find a solution together.

REFERENCES:

1  World Health Organization: Adherence to Long-Term Therapies. WHO Library Cataloguing-in-Publication Data, 1–211. 2003. www.who.int/chp/knowledge/publications/adherence_full_report.pdf

2  Ahmed, R., & Aslani, P. (2014). What is patient adherence? A terminology overview. Int J Clin Pharm, 36(1), 4-7, 2014.

3  Julius RJ, Novitsky MA, Jr., Dubin WR: Medication adherence: A review of the literature and implications for clinical practice. J Psychiatr Pract 15:34–44, 2009.

4  Niemeyer, L., et al., “When I Stop My Medication, Everything Goes Wrong”: Content Analysis of Interviews with Adolescent Patients Treated with Psychotropic Medication. J Child Adolesc Psychopharmacol, 2018. 28(9): p. 655-662.

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