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Thiamine, or vitamin B1, is a water-soluble nutrient essential for converting food into energy and supporting nerve, heart, and immune function. The body stores minimal thiamine, so regular dietary intake is crucial. Deficiency occurs when intake is inadequate, absorption is impaired, or requirements increase.

Common causes include diets centered on polished rice or refined carbohydrates, chronic alcohol use disorder, severe anorexia, bariatric surgery, and conditions like HIV or hyperthyroidism. Infants breastfed by thiamine-deficient mothers are also at risk.

Deficiency manifests in several syndromes. Dry beriberi causes symmetrical peripheral neuropathy with tingling, muscle weakness, and loss of reflexes. Wet beriberi leads to high-output heart failure, causing swelling, shortness of breath, and rapid heartbeat. Wernicke-Korsakoff syndrome, primarily seen in alcohol use disorder, presents with confusion, eye movement abnormalities, gait instability (Wernicke encephalopathy), and severe memory impairment with confabulation (Korsakoff syndrome) if untreated.

Early symptoms are often vague: fatigue, irritability, reduced appetite, and weight loss. Without treatment, irreversible nerve or brain damage may occur. Diagnosis involves clinical evaluation and tests like erythrocyte transketolase activity. Treatment is thiamine replacement—oral for mild cases, parenteral (500–750 mg daily) for severe or neurological involvement, always given before glucose to prevent worsening. Prevention relies on consuming thiamine-rich foods: whole grains, legumes, meat (especially pork), nuts, and yeast.