Vitamin B1 Deficiency in India: Causes, Symptoms, Diagnosis & Treatment

Quick Summary

• Vitamin B1 deficiency in India is mainly linked to polished white rice consumption and low dietary diversity.
• Drinking tea or coffee immediately after meals can reduce thiamine absorption.
• Parboiled (Ushna) rice and millets like ragi and jowar are better dietary choices for prevention.
• Early symptoms like tingling feet or a burning sensation should not be ignored.
• While basic treatment is affordable, severe complications may require hospitalisation.

Introduction

Vitamin B1 deficiency in India is often invisible until it suddenly affects the heart or brain. While India has made progress in addressing macro-nutrient gaps, micronutrient deficiencies such as thiamine (Vitamin B1) depletion continue to affect our populations, particularly in regions dependent on polished white rice. 

Since the human body cannot produce thiamine on its own, it must be obtained daily through diet. However, dietary patterns, socioeconomic disparities, and even common habits such as high tea consumption can compromise B1 levels. Understanding these symptoms and causes can significantly help with early diagnosis and potentially life-saving treatment.

Explore our complete guide on Nutrient Deficiency in India, or read more about other Vitamin Deficiencies in India.

What Is Vitamin B1 (Thiamine) and Why Does It Matter?

Vitamin B1, scientifically known as thiamine, is a water-soluble vitamin that acts as a vital coenzyme in carbohydrate metabolism. In simpler words, it enables the body to convert food into usable energy. Since thiamine is not stored in significant amounts and cannot be synthesized by the body, consistent dietary intake is important.

Thiamine plays a critical role in:

• Energy Production: Helping convert glucose into energy for cells.
• Nervous System Health: Supporting the myelin sheath that protects nerves.
• Brain Function: Assisting cognitive processes and memory.
• Heart Function: Ensuring cardiac muscles generate enough energy to pump blood efficiently.

Quick Answer: What does Vitamin B1 do?

Vitamin B1 (thiamine) helps convert carbohydrates into energy and supports nerve and heart function. Without adequate thiamine, cells cannot produce sufficient energy, leading to fatigue, nerve damage, and serious complications such as beriberi.

What Is Beriberi? Understanding Its Types

Beriberi is a clinical disease caused by severe Vitamin B1 (thiamine) deficiency. It is not a separate illness; rather, it is the advanced stage of untreated thiamine deficiency.

Depending on which part of the body is most affected, beriberi appears in different forms.

Dry Beriberi (Neurological Type)

Dry beriberi mainly affects the peripheral nervous system. It gradually damages the nerves, leading to:

• Tingling or burning sensation in the hands and feet
• Muscle weakness
• Difficulty walking
• Loss of tendon reflexes (such as ankle reflex)
• Muscle wasting in advanced stages

Without treatment, nerve damage can become long-lasting.

Wet Beriberi (Cardiovascular Type)

Wet beriberi affects the heart and circulatory system. This form is a medical emergency.

Because thiamine is essential for heart muscle function, deficiency can lead to:

• Rapid heartbeat
• Severe breathlessness
• Swelling (edema) in the legs
• Enlarged heart
• High-output heart failure

In India, unexplained heart failure in individuals with a polished rice-based diet should always raise suspicion of wet beriberi.

Wernicke–Korsakoff Syndrome (Brain Involvement)

This is a severe form of thiamine deficiency affecting the brain. It is most commonly seen in people with chronic alcohol use.

It can cause:

• Confusion
• Memory loss
• Loss of muscle coordination
• Difficulty maintaining balance

Without urgent treatment, this condition can lead to permanent neurological damage.

Quick Answer: Beriberi is the advanced stage of vitamin B1 deficiency and appears as dry (nerve damage), wet (heart failure), or Wernicke–Korsakoff syndrome (brain involvement).

What are the Early Signs of Vitamin B1 Deficiency in Adults?

In its early stages, thiamine deficiency may appear subtle or resemble general exhaustion. In the Indian clinical context, physicians often look for specific neurological symptoms that go beyond simple tiredness.

Key early symptoms include:

• Persistent fatigue that does not improve with rest
• Loss of appetite or sudden reduced interest in food
• Paresthesia (tingling or burning sensation) in the hands and feet, often described as a burning feeling in the soles
• Irritability and noticeable mood changes
• Difficulty concentrating or “brain fog.”

Quick Answer: Early symptoms include fatigue, irritability, loss of appetite, and tingling or burning sensations in the hands and feet. These nerve-related symptoms (paresthesia) are particularly suggestive of thiamine deficiency and should not be ignored.

Symptoms of Vitamin B1 Deficiency in Children

In children and infants, thiamine deficiency can progress rapidly and may become a medical emergency. 

Common symptoms in children include:

• Feeding difficulties, such as poor latching or sudden refusal to feed
• Frequent vomiting and abdominal discomfort
• Developmental delays or loss of previously achieved milestones
• Cardiac warning signs such as rapid heartbeat (tachycardia) and breathlessness
• An altered cry in infants: sometimes described as a thin, weak, or “silent” cry, which can be a hallmark sign of infantile beriberi

The Pregnancy–Infant Connection: Why Breastfed Infants Are at Risk

This remains a critical concern in Indian maternal health, as noted in the Indian government policy brief on thiamine supplementation. Thiamine is actively transferred into breast milk. If a mother’s diet is low in Vitamin B1, often due to limited dietary diversity or restrictive postpartum food practices, her breast milk may also be deficient. Because infants have minimal thiamine reserves, they can develop infantile beriberi within weeks.

The condition may initially be mistaken for a respiratory infection or congenital heart disease, potentially delaying life-saving treatment.

Quick Answer: Can a mother’s vitamin B1 deficiency affect her baby?
Yes. If a breastfeeding mother is deficient in thiamine, her infant may develop serious symptoms such as a rapid heart rate and breathlessness. Early recognition is essential because prompt thiamine treatment can quickly reverse these life-threatening complications.

What Causes Thiamine Deficiency in India?

B1 deficiency is often the result of everyday eating habits, the way food is processed, and certain common beverages that reduce the body’s ability to use Vitamin B1.

Primary Causes Include:

• High Polished Rice Consumption: In many parts of India, especially in the South and East, polished white rice is the main staple. During milling, the outer layer of the grain (where most of the thiamine is stored) is removed. Over time, depending heavily on polished rice can lead to a deficiency.
• Lack of Dietary Diversity: When meals are mostly refined carbohydrates and lack pulses, legumes, millets like ragi and jowar, nuts, and whole grains, the daily requirement of Vitamin B1 (about 1.1–1.2 mg for adults) may not be met.
• Chronic Alcohol Consumption: Alcohol reduces the body’s ability to absorb thiamine and also depletes stored levels, increasing the risk of nerve and brain complications.
• Gastrointestinal Disorders: Conditions like chronic diarrhoea or celiac disease can prevent proper absorption of vitamins, even if the diet seems adequate.

The Anti-Thiamine Factors: Tea, Coffee, and Paan

One important but often overlooked cause in India is the regular intake of substances that reduce thiamine availability in the body.

• Tea and Coffee: Both contain natural compounds called tannins and catechins. When consumed in large amounts, especially right after meals, they can reduce the amount of thiamine available for absorption.
• Betel Nut (Paan): Frequent chewing of betel nut has been linked to thiamine breakdown. For someone already eating a low-B1 diet, this can significantly increase the risk.

Quick Answer: In India, thiamine deficiency is mainly caused by heavy reliance on polished white rice, low dietary variety, and frequent consumption of tea, coffee, or betel nut that reduces Vitamin B1 absorption.

Polished Rice vs. Parboiled (Ushna) Rice: Why It Matters

Since rice is a staple food for millions, how it is processed makes a major difference.

Feature	Polished White Rice	Parboiled (Ushna) Rice
Processing	The outer husk and bran are removed before cooking	Steamed in the husk before milling
Thiamine Content	Very Low	Higher, as nutrients move into the grain during steaming
Health Impact	Long-term Deficiency risk	More protective against Vitamin B1 deficiency

Parboiled (Ushna) rice retains more Vitamin B1 because the steaming process helps push nutrients from the outer layers into the grain before milling. For families who eat rice daily, this small change can make a meaningful nutritional difference.

Quick Answer: Yes, parboiled (Ushna) rice is better because it retains more Vitamin B1 compared to polished white rice.

Who Is at High Risk of Vitamin B1 Deficiency in India?

While anyone with a poor diet can develop a deficiency, certain groups are more vulnerable:

• Pregnant and Breastfeeding Women: Nutritional needs increase during pregnancy and lactation. If a mother is deficient, her breastfed infant is also at high risk because breast milk reflects the mother’s thiamine levels.
• Low-Income Households: Families depending mostly on subsidized polished rice, without enough pulses, vegetables, or millets, face a higher risk.
• Patients on Dialysis: Since thiamine is water-soluble, some of it can be lost during dialysis treatment.
• Post-Bariatric Surgery Patients: Weight-loss surgeries can reduce the body’s ability to absorb vitamins properly.
• Heavy Tea or Coffee Drinkers: Drinking 5–6 cups daily along with a rice-heavy diet can increase deficiency risk due to reduced thiamine absorption.

How Is Vitamin B1 Deficiency Diagnosed in India?

In many Indian hospitals, especially in rural or district settings, diagnosis is based more on symptoms and diet history than on advanced lab testing.

• Clinical Signs: Doctors look for symptoms like burning sensation in the feet (“jalan”), tingling in hands and feet (paresthesia), reduced ankle reflexes, or unexplained heart problems.
• Dietary Assessment: Understanding how much polished rice, tea, or alcohol a person consumes helps guide diagnosis.
• Response to Treatment: Often, doctors give thiamine and observe how quickly symptoms improve. Rapid improvement strongly supports the diagnosis.
• Laboratory Tests: In larger urban hospitals, blood thiamine levels or specialized tests like erythrocyte transketolase activity may be used. However, these tests are not widely available everywhere in India.

Quick Answer: In India, vitamin B1 deficiency is usually diagnosed based on symptoms and dietary history, with confirmation often seen when symptoms improve quickly after thiamine treatment.

Best Treatment for Vitamin B1 Deficiency in India

The good news is that thiamine deficiency is highly treatable. In many cases, improvement begins within days of starting treatment.

• Oral Supplements: For mild symptoms, such as fatigue, reduced appetite, or early nerve discomfort, doctors usually prescribe Vitamin B1 tablets. These are easily available at local pharmacies and are affordable.
• Injectable Thiamine: In severe cases such as Wet Beriberi (affecting the heart) or Infantile Beriberi, thiamine must be given through injection (IV or IM) in a hospital. This allows rapid correction and can be lifesaving.
• Dietary Changes: Treatment does not stop at medication. Long-term recovery depends on improving diet, replacing polished grains with millets, unpolished rice, or parboiled (Ushna) rice, and adding pulses and legumes.

Quick Answer: The best treatment for vitamin B1 deficiency in India includes oral thiamine tablets for mild cases and hospital-based thiamine injections for severe beriberi, along with long-term dietary changes.

Cost of Treating Vitamin B1 Deficiency in India

Basic thiamine treatment is inexpensive. However, costs rise significantly when the deficiency leads to serious complications.

• Basic Treatment: Oral thiamine tablets are affordable and may cost only a few rupees per day.
• Consultation and Diagnostic Costs: If symptoms involve the heart or nerves, doctors may recommend tests such as an ECG or echocardiography. In private urban clinics, these expenses can range from ₹1,000 to ₹5,000 depending on the facility.
• Emergency Hospitalisation: Severe cases, such as infantile cardiac failure or advanced neurological complications, may require ICU care, oxygen support, injections, and extended hospital stays. At this stage, costs can escalate quickly.

Crowdfunding for Emergency Medical Care

While basic deficiency is inexpensive to treat, hospitalisation for severe wet beriberi or infantile complications can create sudden financial stress for families. In such situations, some families turn to online medical crowdfunding platforms in India, such as ImpactGuru, to raise funds for emergency cardiac or neurological care through verified donation channels.

Natural Food Sources of Vitamin B1 in India

Prevention is always better than treatment. Including naturally rich sources of Vitamin B1 in daily meals can significantly reduce risk.

• Millets: Ragi, Jowar, and Bajra.
• Legumes and Pulses: Moong dal, Rajma, and chickpeas (Chana).
• Nuts and Seeds: Groundnuts (peanuts) and sunflower seeds.
• Whole Grains: Unpolished rice, parboiled (Ushna) rice, and whole wheat.
• Non-Vegetarian Sources: Lean meats and eggs.

Conclusion

Vitamin B1 deficiency in India remains a serious yet preventable health concern. From heavy reliance on polished rice to frequent tea consumption, small everyday habits can quietly increase risk.

Recognising early signs, such as tingling in the feet or unexplained breathlessness, can prevent severe complications. Choosing more diverse grains like ragi and parboiled (Ushna) rice, along with pulses and nuts, can protect families from avoidable health and financial distress.

Sources
https://iris.who.int/server/api/core/bitstreams/d0b1e966-95f7-440a-bb3d-e4dd52989b11/content

https://htain.dhr.gov.in/images/pdf/Policy_Briefs/63.Policy_brief_CEA_Thiamine_suppl_v4.pdf

https://www.indianpediatrics.net/aug2019/673.pdf