Meta Information
ID:thiamine
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/intervention/magnesium
Target name:
Magnesium
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium is an essential cofactor required to convert thiamine into its biologically active form, thiamine pyrophosphate (TPP), which is critical for energy metabolism.
Actionable advice:
Adequate magnesium intake should be maintained, as thiamine supplementation may be ineffective in magnesium-deficient states.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
By integrating recent advances in metallomics and mitochondrial biology, this review summarizes the roles of six key metal ions-iron (Fe2+), copper (Cu+), sodium (Na+), calcium (Ca2+), zinc (Zn2+), and magnesium (Mg2+)-in mitochondrial energy metabolism and the regulation of cell fate.
Label source:
PubMed: The Role of Metal Ions in Mitochondria: From Energy Metabolism to Cell Destiny. (PMID 42018027)
Action type:
informational_none
Target id:
/class/loop-diuretics
Target name:
Loop Diuretics (e.g., Furosemide)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Loop diuretics significantly increase the urinary excretion of thiamine, which can lead to severe deficiency, particularly with long-term use in conditions like heart failure.
Actionable advice:
If taking loop diuretics long-term, discuss thiamine supplementation with your healthcare provider to prevent deficiency.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Long-term furosemide therapy is associated with increased urinary loss of thiamine.
Label source:
PubMed: Urinary thiamine excretion in the rat: effects of furosemide, other diuretics, and volume load. (PMID 10482307)
Action type:
informational_none
Target id:
/dietary/alcohol-acute
Target name:
Alcohol (Acute Consumption)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chronic alcohol consumption is a primary cause of thiamine deficiency by impairing its absorption from the intestine and its activation in the liver.
Actionable advice:
Alcohol intake should be avoided or strictly limited; individuals with chronic alcohol use require significantly higher thiamine intake.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Chronic alcohol consumption can result in thiamine deficiency by causing inadequate nutritional thiamine intake, decreased absorption of thiamine from the gastrointestinal tract, and impaired thiamine utilization in the cells.
Label source:
PubMed: Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism (2003)
Source url:
Exact phrase from label:
Recent findings on the effects of alcohol on thiamine absorption and storage and on thiamine phosphorylation to the enzyme co-factor form (thiamine diphosphate) are discussed with regard to the postulated "biochemical lesion" of Wernicke encephalopathy.
Label source:
PubMed: Addiction biology (1999)
Source url:
Exact phrase from label:
Current research has elucidated the relationship of alcohol consumption on glucose, glutamine, vitamins B1 (thiamine), B2 (riboflavin), B9 (folate), C (ascorbic acid), selenium, iron, and zinc absorption within the small intestine.
Label source:
PubMed: Nutrients (2023)
Action type:
avoid
Target id:
/condition/heart-failure
Target name:
Heart Failure
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Thiamine deficiency is common in patients with heart failure, due to poor nutrition, diuretic use, and malabsorption, and can worsen cardiac function.
Actionable advice:
Patients with heart failure, especially those on diuretics, should have their thiamine status monitored and supplement as advised by a physician.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
PURPOSE: To test the hypothesis that long-term furosemide therapy in patients with congestive heart failure (CHF) is associated with clinically significant thiamine deficiency via urinary loss.
Label source:
PubMed: Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study. (PMID 1867241)
Action type:
monitor
Target id:
/procedure/bariatric-surgery
Target name:
Bariatric Surgery
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Anatomical changes from bariatric surgery can severely impair thiamine absorption, placing patients at high risk for developing neurological complications like Wernicke's encephalopathy.
Actionable advice:
Strict adherence to post-bariatric surgery vitamin protocols, including thiamine, is essential.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Malnourishment-related WE is a rare but severe and preventable consequence of bariatric surgery that warrants attention given its rapid onset and detrimental course
Label source:
Primary literature: https://pmc.ncbi.nlm.nih.gov/articles/PMC6018594/
Action type:
informational_none
Target id:
/intervention/fluorouracil-5-fu
Target name:
Fluorouracil (5-FU) Chemotherapy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The chemotherapy agent 5-FU inhibits the enzyme that converts thiamine to its active form, potentially inducing acute thiamine deficiency and severe neurological symptoms.
Actionable advice:
5-fluorouracil can precipitate acute thiamine deficiency (Wernicke's). If you're receiving 5-FU, ask your oncologist about thiamine supplementation and report confusion or balance problems immediately.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
5-FU has been shown to induce thiamine depletion. Patients receiving 5-fluorouracil (5-FU) have shown to have an increased thiamine metabolism and subsequently low thiamine levels
Label source:
Primary literature: https://pmc.ncbi.nlm.nih.gov/articles/PMC3177792/
Action type:
monitor
Target id:
/dietary/tannin-rich-beverages
Target name:
Tea and Coffee
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
1
Description:
Tannins and other polyphenols in tea and coffee can bind to thiamine in the gut, forming an insoluble complex that prevents its absorption.
Actionable advice:
Thiamine supplements and coffee or tea should be separated by at least one hour.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Consumption of food high in tannins can cause thiamin deficiency. The interactions between tannic acid and thiamin were studied by allowing them to react at pH 7.5, 60 C, and determining free remaining thiamin by the thiochrome method and by recording changes in ultraviolet absorption profiles at intervals.
Label source:
PubMed: The American journal of clinical nutrition (1977)
Source url:
Exact phrase from label:
It was observed, in vitro, that the water extract of the fermented-tea customarily chewed by Thai people has a similar thermostable thiamine-inactivating factor to that found in the water extract of fern.
Label source:
PubMed: Journal of nutritional science and vitaminology (1976)
Source url:
Exact phrase from label:
The relationship of folate status and polyphenol intake to thiamin status was studied in 80 randomly selected elderly and young Irish women, with key variables affecting thiamin nutrition controlled for.
Label source:
PubMed: The American journal of clinical nutrition (1990)
Action type:
separate
Target id:
/class/proton-pump-inhibitors
Target name:
Proton Pump Inhibitors (PPIs)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Long-term use of acid-suppressing medications like PPIs can reduce thiamine absorption, as it requires an acidic environment for optimal uptake.
Actionable advice:
If on long-term PPI therapy, be aware of the risk for thiamine deficiency and consider periodic monitoring.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
(5.1)
• Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer • Acute Interstitial Nephritis: Observed in patients taking PPIs.
Label source:
Action type:
monitor
Target id:
/dietary/raw-fish-shellfish
Target name:
Raw Fish and Shellfish
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Certain types of raw fish, ferns, and shellfish contain thiaminase, an enzyme that actively destroys thiamine, leading to deficiency with regular consumption.
Actionable advice:
Cook fish and shellfish thoroughly to inactivate the thiaminase enzyme.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Betel nuts and raw fermented fish possess antithiamin activity. Abstention from both betel nut chewing and raw fermented fish consumption resulted in a significant reduction of thiamin pyrophosphate effect.
Label source:
PubMed: The American journal of clinical nutrition (1975)
Source url:
Exact phrase from label:
Thiaminase induced thiamine deficiency occurs in fish, humans, livestock and wild animals.
Label source:
PubMed: Journal of Great Lakes research (2010)
Source url:
Exact phrase from label:
Other less frequent causes are the ingestion of raw fish contaminated with microbial thiaminases, inborn errors of metabolism and total parenteral nutrition.
Label source:
PubMed: Nutricion hospitalaria (1994)
Action type:
informational_none
Target id:
/condition/renal-impairment
Target name:
Renal Impairment / Dialysis
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Patients with kidney disease, particularly those on hemodialysis, experience increased clearance of water-soluble vitamins like thiamine, increasing deficiency risk.
Actionable advice:
Patients on dialysis should follow a renal vitamin protocol that includes thiamine supplementation.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
After the dialysis procedure, significantly lower concentrations of serum folate (37%), plasma PLP (35%), blood thiamine (6%) and blood riboflavin (7%) were observed.
Label source:
PubMed: Nephrology (Carlton, Vic.) (2008)
Source url:
Exact phrase from label:
The inclusion of supplementation with thiamine and other water-soluble vitamins, especially in peritoneal dialysis and hemodialysis patients, is necessary for reducing dialysis losses.
Label source:
PubMed: Nutrients (2023)
Source url:
Exact phrase from label:
Deficiencies of water-soluble vitamins may occur in uremic patients mainly because of restricted consumption and of loss during chronic hemo- and peritoneal dialysis.
Label source:
PubMed: Blood purification (1985)
Action type:
informational_none
Target id:
/intervention/b-complex
Target name:
B-Complex Vitamins
Severity:
moderate
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Thiamine functions as part of a complex network of B vitamins; its metabolic pathways are interconnected with B2, B3, B6, B9, and B12.
Actionable advice:
Thiamine is best taken as part of a B-complex supplement, or a diet rich in all B vitamins is a good idea for balanced metabolic support.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We used weighted quantile sum (WQS) regression to evaluate the collective impact of 6 dietary B vitamins (thiamin, riboflavin, folate, niacin, and vitamins B-6 and B-12) on 1) the proportion of arsenic metabolites in urine and 2) 6 CVD-related markers [including urinary 15-F2t-isoprostane (15-F2t-IsoP)] among 418 participants (26-75 y of age) from the New Hampshire Health Study.
Label source:
PubMed: Dietary B Vitamin Intake Is Associated with Lower Urinary Monomethyl Arsenic and Oxidative Stress Marker 15-F2t-Isoprostane among New Hampshire Adults. (PMID 29070711)
Action type:
informational_none
Target id:
/dietary/high-carbohydrate-meal
Target name:
High Refined Carbohydrate Diet
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Thiamine is a critical cofactor for carbohydrate metabolism. A diet high in refined carbohydrates and sugar increases the body's demand for thiamine.
Actionable advice:
Higher thiamine intake is a good idea if consuming a diet rich in refined carbohydrates to support energy metabolism.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Because thiamine is a major factor in the metabolism of glucose, it has long been known that ingestion of simple carbohydrates, processed in the body mainly to glucose, automatically increases the need for dietary thiamine
Label source:
Primary literature: https://pmc.ncbi.nlm.nih.gov/articles/PMC1375232/
Action type:
informational_none
Target id:
/class/anticonvulsants
Target name:
Anticonvulsant Medications (e.g., Phenytoin)
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Long-term therapy with certain anticonvulsant drugs, such as phenytoin, has been associated with lower blood levels of thiamine.
Actionable advice:
If on long-term anticonvulsant therapy, discuss your nutritional status, including thiamine, with your doctor.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Thiamine and folate levels in blood and cerebrospinal fluid (CSF) were determined by microbiological assays in 23 control subjects and 11 phenytoin-treated epileptics.
Label source:
PubMed: Cerebrospinal fluid and blood thiamine concentrations in phenytoin-treated epileptics. (PMID 7093823)
Action type:
informational_none
Target id:
/intervention/metformin
Target name:
Metformin
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Some evidence suggests that long-term metformin use may interfere with thiamine transport within cells, though this interaction is less established than its effect on vitamin B12.
Actionable advice:
While taking metformin, ensure adequate intake of B vitamins, including thiamine and B12.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Additionally, various prescribed medicines, including metformin and fedratinib, manipulate thiamine transporters, complicating the therapeutic effect.
Label source:
PubMed: Substrate transport and drug interaction of human thiamine transporters SLC19A2/A3. (PMID 39738067)
Action type:
informational_none
Target id:
/intervention/alpha-lipoic-acid
Target name:
Alpha-Lipoic Acid (ALA)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Both thiamine (as TPP) and ALA are essential cofactors for the same key enzyme complexes (pyruvate dehydrogenase and α-ketoglutarate dehydrogenase) in cellular energy production.
Actionable advice:
Consider taking ALA and thiamine together to synergistically support mitochondrial function and energy metabolism.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
A Western blot analysis revealed a reduced expression of LIPT1 and absent expression of lipoylated pyruvate dehydrogenase E2 (PDH E2) and alpha-ketoglutarate dehydrogenase E2 (α-KGDH E2) subunits. Accordingly, activities of PDH and α-KGDH were markedly reduced, associated with cell bioenergetics failure, iron accumulation, and lipid peroxidation.
Label source:
PubMed: Antioxidants (Basel, Switzerland) (2024)
Source url:
Exact phrase from label:
The transacetylase component has two lipoic acid residues on each of its polypeptide chains that can be modified by N-[(3)H]ethylmaleimide in the presence of pyruvate and thiamin pyrophosphate.
Label source:
PubMed: Proceedings of the National Academy of Sciences of the United States of America (1978)
Source url:
Exact phrase from label:
Dihydrolipoamide dehydrogenase (DLD) deficiency is a recessive mitochondrial disorder caused by depletion of DLD from α-ketoacid dehydrogenase complexes.
Label source:
PubMed: JCI insight (2022)
Action type:
informational_none
Target id:
/dietary/sulfite-containing-foods
Target name:
Foods with Sulfite Preservatives
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Sulfites, used as preservatives in wine, dried fruits, and some processed foods, can chemically cleave and inactivate thiamine.
Actionable advice:
Intake of foods and beverages high in sulfites is generally best limited to preserve thiamine status.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Measurements of urinary thiamine excretion revealed substantial reduction at one week and particularly at 13 weeks, in all groups receiving more than 0.125% sulfite in the diet
Label source:
Primary literature: https://www.inchem.org/documents/jecfa/jecmono/v18je14.htm
Action type:
informational_none