7. Deficiency

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Thiamine deficiency is often overlooked in modern medicine, yet it persists in alcoholism, malabsorption syndromes, chronic illness, and high-carbohydrate diets.

Progression:

• Early signs: Fatigue, irritability, poor concentration, mild neuropathy.

• Moderate deficiency: Muscle weakness, anorexia, gastrointestinal discomfort, mood changes.

• Severe deficiency syndromes:

  • Dry beriberi: Peripheral neuropathy, muscle wasting, foot drop.

  • Wet beriberi: Cardiac enlargement, tachycardia, heart failure with edema.

  • Wernicke’s encephalopathy: Confusion, ataxia, ophthalmoplegia; can progress to coma.

  • Korsakoff’s psychosis: Chronic amnesia and confabulation due to permanent brain damage.

Mechanistic basis: Energy failure in neurons and cardiomyocytes, lactic acidosis, and increased oxidative stress are central to thiamine deficiency pathology.