Thiamin (vitamin B1) deficiency in diabetics

What is thiamin?

Thiamin (or thiamine) is one of the water-soluble B vitamins. It is also known as vitamin B1.

What does thiamin do?

The body needs thiamin to convert carbohydrates into glucose, the main source of energy in the body. As thiamin is an essential co-factor in carbohydrate metabolism, low levels are thought to have an impact on glucose control in the body.

What foods contain thiamin?

Vegetables containing thiamin include broccoli, onions, green beans, carrots, kale, and tomatoes. More nutrient-rich and ranking as very good sources of vitamin B1 are green peas, Brussels sprouts, spinach, cabbage, aubergine and romaine lettuce.

Thiamin deficiency in diabetics - the research

Thiamin levels are lower in diabetics in part because the elevated blood sugar causes increased thiamin excretion by the kidney at a rate twenty-five times higher than normal. This leads to an acute deficiency of thiamin -  a conditional also known as beri-beri.

In diabetes the small blood vessels in the body can become damaged. When the blood vessels that supply blood to the kidneys are involved, the kidneys stop working correctly and important proteins, such as albumin, are lost from the blood into the urine.

In 2007 researchers from the Department of Biological Sciences at the University of Essex, UK, lead by P. J. Thornalley recruited 26 Type 1 diabetics and 48 Type 2 diabetics and 20 healthy volunteers to compare against. The study found that compared to the controls, Type 1 and Type 2 diabetics had, respectively, 76% and 75% lower blood-plasma thiamin levels.

Diabetics excrete thiamin much faster

Furthermore, Thornalley examined how the body processes thiamin and found that compared to the controls, Type 1 and Type 2 diabetics excreted thiamin through the urine 24 times faster and 16 times faster, respectively. The researchers found additional new studies showing that high doses of thiamin prevented the small-blood-vessel damage common in diabetes and theorised that diabetics might need more thiamin.

Thiamin in diabetic patients produced regression of early diabetic renal disease

A 2009 double blind clinical trial of high dose thiamine published in Diabetologia by Dr Rabbani from Warwick Medical Centre, found that treatment of thiamin in diabetic patients produced regression of early diabetic renal disease. This was a pilot study of 40 patients with type 2 diabetes over 12 weeks. 

A third of the patients in the study saw a return to normal urinary albumin excretion after being treated with high dose (300mg) thiamin taken orally each day for three months. The experts say thiamin works by helping protect cells against the harmful effects of the high blood sugar levels found in diabetes.

A thiamin supplement could benefit most people with both type 1 and type 2 diabetes

According to the researchers Warwick University, this low cost and readily available supplement could benefit most people with both type 1 and type 2 diabetes as between 70% and 90% of people with diabetes are thiamin deficient.

These findings were confirmed in a subsequent study from Pakistan (Alam et al, 2012), again using 300 mg of thiamin each day for 3 months. In this study, low thiamin levels did not appear to be related to dietary intake, rather to enhanced excretion through the renal system. Alam recommended that people with type 2 diabetes take 300 mg of thiamin daily to prevent depreciation of thiamin levels in the body. The study did not find adverse effects from this therapy.

Thiamin deficiency linked with progressive atherosclerosis disease commonly found in diabetic patients

A notable review article published in the 2011 issue of the International Journal of Clinical Practice clearly links thiamin deficiency with the progressive atherosclerosis disease commonly found in diabetic patients with “metabolic syndrome”.  Metaboic syndrom is defined as the biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes. The author, Dr Page, stated:

“Individuals with diabetes are thiamine deficient. The pathophysiology of recognised complications of thiamine deficiency is similar to that underlying atherosclerosis and the metabolic syndrome, namely oxidative stress, inflammation and endothelial dysfunction…

Thiamine deficiency occurs in individuals with diabetes, which leads to hyperglycaemic-induced damage…Thiamine administration can prevent the formation of harmful by-products of glucose metabolism, reduce oxidative stress and improve endothelial function. The potential benefit of long-term replacement in those with diabetes is not yet known but may reduce cardiovascular risk and angiopathic complications.”