Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

Thiamine (also spelled "thiamin") is a vitamin, formerly known as vitamin B1. Thiamine was one of the first compounds recognized as a vitamin.

Thiamine is involved in many body functions, including nervous system and muscle function, the flow of electrolytes in and out of nerve and muscle cells, digestion, and carbohydrate metabolism. Very little thiamine is stored in the body and depletion can occur within 14 days. Severe thiamine deficiency may lead to serious complications involving the nervous system, brain, muscles, heart, and stomach and intestines.

Dietary sources of thiamine include beef, brewer's yeast, legumes (beans, lentils), milk, nuts, oats, oranges, pork, rice, seeds, wheat, whole-grain cereals, and yeast. In industrialized countries, food made with white rice or white flour is often enriched with thiamine.

Thiamine is used as part of a treatment for metabolic disorders and thiamine deficiency symptoms, as well as in alcoholics. It has been studied for other uses, but conclusions are lacking at this time.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

The following doses are the U.S. recommended daily allowance (RDA) of thiamine taken by mouth: in adults 19 and older, 1.2 milligrams for males and 1.1 milligrams for females; and in pregnant or breastfeeding women of any age, 1.4 milligrams. Doses of 1-2 milligrams have been taken by mouth daily as a dietary supplement in adults. In people who have or are at risk of thiamine deficiency, 50 milligrams of thiamine have been taken by mouth daily, and doses of 50-100 milligrams of thiamine have been injected into the vein 3-4 times daily.

For Alzheimer's disease, 3 milligrams of thiamine has been taken by mouth daily in three divided doses for up to one year.

For menstrual cramps, 100 milligrams of thiamine has been taken by mouth daily for three months.

For epilepsy, 50 milligrams of thiamine has been taken by mouth daily for six months.

For alcohol withdrawal, 100 milligrams of thiamine hydrochloride has been injected into the muscle or vein.

For alcohol liver disease, 100 milligrams of thiamine has been injected into the vein.

For coma or hypothermia (dangerously low body temperature) of unknown origin, 100 milligrams of thiamine has been injected into the muscle or vein.

For thiamine deficiency caused by nutrition delivered through the vein, 100 milligrams of thiamine has been injected into the vein.

For Wernicke-Korsakoff syndrome (a brain disorder caused by thiamine deficiency), 5-200 milligrams of thiamine have been injected into the muscle or vein, sometimes in divided doses for over two days, or at least 100 milligrams of thiamine has been injected into the vein or muscle.

Children (younger than 18 years)

The following doses of thiamine taken by mouth are considered to be adequate intake (AI): 0.2 milligrams in infants 0-6 months old; 0.3 milligrams in infants 7-12 months old; 0.5 milligrams in children 1-3 years old; 0.6 milligrams in children 4-8 years old; 0.9 milligrams in children 9-13 years old; 1.2 milligrams in males 14-18 years old; and 1 milligram in females 14-18 years old. The RDA for pregnant or breastfeeding women of any age is 1.4 milligrams daily.

Evidence

These uses have been tested in humans or animals.  Safety and effectiveness have not always been proven.  Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Key to grades

A
Strong scientific evidence for this use
B
Good scientific evidence for this use
C
Unclear scientific evidence for this use
D
Fair scientific evidence against this use (it may not work)
F
Strong scientific evidence against this use (it likely does not work)

Grading rationale

Evidence gradeCondition to which grade level applies
A

Metabolic disorders

Taking thiamine by mouth may help some complications of metabolic disorders associated with genetic diseases. These include: Leigh's disease (a nervous system disorder causing movement problems), maple syrup urine disease (protein breakdown disorder in which urine smells like maple syrup), pyruvate carboxylase deficiency (rare disorder causing developmental problems in babies), and high blood levels of alanine, an amino acid. Long-term management should be under strict medical supervision.
A

Thiamin deficiency

Humans depend on diet for their thiamine needs. Very little thiamine is stored in the body and depletion can occur within 14 days. Severe thiamine deficiency may lead to serious complications involving the nervous system, brain, muscles, heart, and stomach and intestines. Thiamine deficiency can be associated with alcoholism, poor nutrition, cancer, vomiting associated with pregnancy, bariatric surgery, and hemodialysis. Some people may be more at risk of thiamine deficiency. Those with thiamine deficiency or related conditions should receive supplemental thiamine under medical supervision.
B

Alcoholism

Alcoholics or those experiencing alcohol withdrawal are at risk of thiamine deficiency and its associated complications. Thiamine has been injected into the vein with other nutrients. Further research is needed on the impact of thiamine on alcoholism.
B

Total parenteral nutrition (TPN)

Thiamine has been added to total parenteral nutrition (TPN, nutrition given through the veins) for people who cannot receive thiamine by mouth, such as a multivitamin.
C

Alzheimer's disease

Thiamine deficiency can result in a form of dementia. The relationship of thiamine to Alzheimer's disease and other forms of dementia has been studied. However, there is still controversy over whether thiamine supplementation may benefit people with Alzheimer's disease. More research is needed before a firm conclusion can be made.
C

Anemia

Thiamine-responsive megablastic anemia (TRMA) is a genetic disorder that affects thiamine transport and conversion in the body. Thiamine has been studied for heart problems associated with TRMA, as well as other TRMA symptoms. More information is needed in this area.
C

Athletic performance

Active people who reduce food intake may have a higher risk of vitamin deficiency, including thiamine deficiency. More research is needed in this area.
C

Blood vessel clots

B vitamins have been studied for the treatment of clots in blood vessels. Further research is needed in order to form conclusions.
C

Cancer

Thiamine deficiency has been seen in some people with cancer, possibly due to medication use or poor nutrition. Currently, it remains unclear whether thiamine supplementation may benefit any particular types of cancer. Supplementation may be needed in people with cancer who have or are at risk of thiamine deficiency.
C

Cataract prevention

Early evidence suggests that high dietary thiamine intake may help reduce the risk of cataracts. Further study is needed before a firm conclusion can be made.
C

Cerebellar ataxia (movement disorder due to brain cell damage)

Early research suggests that thiamine supplementation may benefit people with cerebellar ataxia after an illness involving fever. Further research is needed.
C

Clogged arteries

Blood sugar imbalances may increase the risk of clogged arteries. Thiamine has been studied as a way to help widen narrowed arteries. Regular thiamine intake may improve blood vessel function and slow the progression of clogged arteries in people with blood sugar imbalances. Further study is needed.
C

Coma/hypothermia of unknown origin

Thiamine is often recommended in people with coma or hypothermia (dangerously low body temperature) of unknown origin. Thiamine has been studied in people with reduced consciousness due to poisoning. More research is needed.
C

Crohn's disease

Low thiamine levels have been reported in people with Crohn's disease (a form of inflammatory bowel disease). It is not clear whether regular thiamine intake may benefit people with this disease in general.
C

Diabetic complications

Thiamine has been studied for complications associated with diabetes, involving the nervous system, eyes, blood vessels, and kidneys. Thiamine may improve complications such as increased urination, high levels of glucose in the urine, and high blood cholesterol levels. Regular thiamine intake may also help slow the progression of clogged arteries in some diabetics. More research is needed in this field.
C

Epilepsy

Early research suggests that thiamine may improve attention and mental function in people who have epilepsy. Further research is needed.
C

Heart failure

Long-term thiamine deficiency may cause heart failure, which requires thiamine supplementation. It is unclear whether thiamine supplementation may benefit people who have heart failure due to other causes. However, it is reasonable for those with heart failure to take a daily multivitamin including thiamine. More evidence is needed before a firm conclusion can be made.
C

Kidney dysfunction

Vitamin deficiency, including thiamine deficiency, has been linked to long-term kidney dysfunction. Taking a multivitamin is often suggested. However, further research is needed in this field.
C

Leg cramps

Vitamin B supplements have been used to treat leg cramps during pregnancy. However, more studies are needed to determine if this is effective.
C

Menstrual cramps

Early evidence suggests that thiamine may be effective for menstrual cramps. Further research is needed to confirm these results.
C

Mitochondrial disorders

Thiamine has been studied as a treatment for mitochondrial disorders, which occur when there are defects in the mitochondria (a part of the cell that produces energy). More research is needed before conclusions can be made.
C

Pyruvate dehydrogenase deficiency (PDH)

PDH is a disorder caused by the buildup of lactic acid, which may be life-threatening and cause nervous system problems. Early evidence suggests that thiamine supplementation may benefit children with PDH. Further evidence is needed before a firm conclusion can be reached.
C

Rheumatism (joint problems)

Early evidence suggests that B vitamins may reduce pain. Further research is needed to determine the effectiveness of thiamine in rheumatism and related disorders.
C

Temporomandibular joint disorder (TMJ)

TMJ is a disorder of the chewing muscles and joints. A combination of indomethacin and thiamine has been studied for this condition, but was found to be less effective than acupuncture. More research is needed in this field.
C

Thiamin deficiency (elderly people)

Thiamine levels may be lower in elderly people, although there is typically a lack of symptoms. There is limited evidence that thiamine supplementation may benefit people who have low thiamine blood levels. However, general multivitamin use has been suggested in elderly people. More research is needed before a firm conclusion can be made.
D

Hip fractures

Early evidence shows that thiamine lacks benefit for hip fractures. However, research is limited and further study is needed.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Abnormal heart rhythms, aging, AIDS/HIV, amnesia, antioxidant, arthritis, Bell's palsy (disorder of nerve that controls face muscles), bladder control, brain damage, canker sores, circulation improvement, death and dying, delirium, Down's syndrome, drug withdrawal, encephalopathy (brain disease), erectile dysfunction, eye disorders, fibromyalgia (long-term body-wide pain), Guillain-Barre syndrome (disorder in which immune system attacks nervous system), hair loss, hepatic encephalopathy (confused thinking due to liver disorders), high blood pressure, insect repellant, kidney failure, lactic acidosis (lactic acid build up), learning, liver damage from drugs or toxins, liver disease, loss of appetite, low back pain, lung disorders, malaria, memory enhancement, menstrual problems, migraine, mood, motion sickness, multiple sclerosis, muscle weakness, myelodysplastic syndrome (disorder of blood cells in the bone marrow), nervous system disorders, neuropathy (nerve damage), optic nerve dysfunction, pain, parasites, poisoning, radiation side effects, refeeding syndrome prevention (metabolic disorders caused by feeding after starvation or poor nutrition), stomach disorders, stress, sudden infant death syndrome (SIDS), tetanus (bacterial infection of the nervous system), tissue healing after surgery, vitamin and nutrient deficiency, weight loss.

Interactions

Interactions with Drugs

Thiamine may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.

Caution is advised when using medications that lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Thiamine may also interact with agents that affect the immune system, agents that enhance athletic performance, agents that promote urination, agents that treat retrovirus infections (HIV), agents that widen blood vessels, agents used for heart disorders, alcohol, Alzheimer's agents, antacids, antibiotics, anticancer agents, barbiturates, birth control taken by mouth, dextrose, dichloroacetate, flumazenil, heart rate-regulating agents, ifosfamide, metformin, naloxone, nervous system agents, neuromuscular blocking agents, pain relievers, phenytoin, thyroid hormone, tobacco, and weight loss agents.

Interactions with Herbs and Dietary Supplements

Caution is advised when using herbs or supplements that may lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Thiamine may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.

Thiamine may also interact with Alzheimer's herbs and supplements, antacids, antibacterials, anticancer herbs and supplements, benfotiamine, betel nuts, birth control taken by mouth, heart rate-regulating herbs and supplements, herbs and supplements that affect the immune system, herbs and supplements that enhance athletic performance, herbs and supplements that promote urination, herbs and supplements that widen blood vessels, herbs and supplements used for heart disorders, horsetail, nervous system herbs and supplements, neuromuscular herbs and supplements, pain relievers, polyphenols, sedatives, thyroid herbs and supplements, tobacco, vitamins, and weight loss herbs and supplements.

Methodology

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Related terms

Allithiamine, aneurine, aneurine HCl, aneurine mononitrate, antiberiberi factor, antiberiberi vitamin, antineuritic factor, antineuritic vitamin, anurine, B-complex vitamin, benfotiamine, beta-hydroxy-ethylthiazolium chloride, sulfotiamine, thiamin chloride, thiamin diphosphate, thiamin HCl, thiamin hydrochloride, thiamin monophosphate (TMP), thiamin nitrate, thiamin pyrophosphate (TPP), thiamin tetrahydrofurfuryl disulfide, thiamin triphosphate (TTP), thiamine, thiamine chloride, thiamine diphosphate, thiamine HCl, thiamine hydrochloride, thiamine monophosphate (TMP), thiamine nitrate, thiamine pyrophosphate (TPP), thiamine tetrahydrofurfuryl disulfide, thiamine triphosphate (TTP), thiaminium chloride HCl, thiaminium chloride hydrochloride.

Dietary sources of thiamine: Beef, brewer's yeast, legumes (beans, lentils), nuts, oats, pork, rice, seeds, wheat, whole-grain cereals, yeast, fruit (such as oranges), milk, milk products, and fortified white rice or white flour products.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with a known allergy or sensitivity to any parts in thiamine supplements. Rare, life-threatening allergic reactions have been reported after multiple doses of thiamine injected into the vein, muscle, or skin.

Side Effects and Warnings

Thiamine is likely safe when taken by mouth daily in amounts considered to be RDA: in adults 19 and older, 1.2 milligrams for males and 1.1 milligrams for females; and in pregnant or breastfeeding women of any age, 1.4 milligrams. Thiamine is likely safe in adults as a supplement when taken by mouth daily in doses of 1-2 milligrams. Thiamine is likely safe in people with or at risk of thiamine deficiency, in doses of 50 milligrams taken by mouth daily. The following doses of thiamine are likely safe in children when taken by mouth daily: 0.2 milligrams in infants 0-6 months old; 0.3 milligrams in infants 7-12 months old; 0.5 milligrams in children 1-3 years old; 0.6 milligrams in children 4-8 years old; 0.9 milligrams in children 9-13 years old; 1.2 milligrams in males 14-18 years old; and 1 milligram in females 14-18 years old.

The following doses of thiamine are considered to be possibly safe: 50-100 milligrams taken by mouth daily for 3-6 months; 50-100 milligrams injected into the vein 3-4 times daily; and 5-200 milligrams injected into the muscle in five divided doses over two days.

Thiamine may cause low blood pressure. Caution is advised in people who have low blood pressure or those taking drugs that lower blood pressure.

Caution is advised in people with diabetes or high blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar or that widen blood vessels.

Use cautiously in breastfeeding women, people who have abnormal heart rates, and those receiving chemotherapy.

Avoid high doses of thiamine injected into the vein or brain. Avoid doses higher than those found in marketed products, unless under the advice of a health professional.

Avoid in people with a known allergy or sensitivity to any parts in thiamine supplements.

Avoid using in the absence of vitamin B6 and nicotinamide, as life-threatening brain damage may occur.

Thiamine may cause drowsiness, excitation, immune changes, increased cancer risk, muscle relaxation, seizures (when injected into the vein or brain), skin irritation (burning or itching), slow heart rate, weight changes, and widened blood vessels.

Pregnancy and Breastfeeding

The RDA for pregnant or breastfeeding women of any age is 1.4 milligrams daily.

There is a lack of scientific evidence on the use of thiamine during pregnancy or breastfeeding. Use cautiously in breastfeeding women.

Selected references

  1. Balakumar P, Rohilla A, Krishan P, et al. The multifaceted therapeutic potential of benfotiamine. Pharmacol Res 2010;61(6):482-488.
  2. Butt AM, Tahir S, Nasrullah I, et al. Mycoplasma genitalium: a comparative genomics study of metabolic pathways for the identification of drug and vaccine targets. Infect.Genet.Evol 2012;12(1):53-62.
  3. Donnino MW, Cocchi MN, Smithline H, et al. Coronary artery bypass graft surgery depletes plasma thiamine levels. Nutrition 2010;26(1):133-136.
  4. Frank P and Crookes PF. Short- and long-term surgical follow-up of the postbariatric surgery patient. Gastroenterol.Clin North Am 2010;39(1):135-146.
  5. Jesse S and Ludolph AC. [Thiamine, pyridoxine and cobalamine. From myths to pharmacology and clinical practice]. Nervenarzt 2012;83(4):521-532.
  6. Kumar N. Neurologic presentations of nutritional deficiencies. Neurol.Clin 2010;28(1):107-170.
  7. Lima LF, Leite HP, and Taddei JA. Low blood thiamine concentrations in children upon admission to the intensive care unit: risk factors and prognostic significance. Am J Clin Nutr 2011;93(1):57-61.
  8. Lombardi G, Zustovich F, Nicoletto MO, et al. Important role of thiamine in preventing ifosfamide-induced encephalopathy. J Oncol Pharm Pract 2010;16(2):135-136.
  9. Manzanares W and Hardy G. Thiamine supplementation in the critically ill. Curr.Opin.Clin.Nutr.Metab Care 2011;14(6):610-617.
  10. Martel F, Monteiro R, and Calhau C. Effect of polyphenols on the intestinal and placental transport of some bioactive compounds. Nutr Res Rev 2010;23(1):47-64.
  11. Rogovik AL, Vohra S, and Goldman RD. Safety considerations and potential interactions of vitamins: should vitamins be considered drugs? Ann Pharmacother 2010;44(2):311-324.
  12. Smit AJ and Gerrits EG. Skin autofluorescence as a measure of advanced glycation endproduct deposition: a novel risk marker in chronic kidney disease. Curr Opin.Nephrol.Hypertens 2010;19(6):527-533.
  13. Tabarki B, Al-Shafi S, Al-Shahwan S, et al. Biotin-responsive basal ganglia disease revisited: clinical, radiologic, and genetic findings. Neurology 1-15-2013;80(3):261-267.
  14. Thorarinsson BL, Olafsson E, Kjartansson O, et al. [Wernicke's encephalopathy in chronic alcoholics]. Laeknabladid 2011;97(1):21-29.
  15. Zhou K, Zhao R, Geng Z, et al. Association between B-group vitamins and venous thrombosis: systematic review and meta-analysis of epidemiological studies. J.Thromb.Thrombolysis 2012;34(4):459-467.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com