Vitamine B1

Synoniem: 
Antiberiberi Factor
Antiberiberi Vitamin
Antineuritic Factor
Antineuritic Vitamin
Aneurine Hydrochloride
Anurine
Chlorhydate de Thiamine
Chlorure de Thiamine
Facteur Anti-béribéri
Facteur Antineuritique
Hydrochlorure de Thiamine
Mononitrate de Thiamine
Nitrate de Thiamine
Thiamine Chloride
Thiamine HCl
Thiamine Hydrochloride
Thiamine Mononitrate
Thiamine Nitrate
Thiaminium Chloride Hydrochloride
Tiamina
Vitamina B1
Vitamine Anti-béribéri
Vitamine Antineuritique
Vitamine B1

Wetenschappelijke naam

Thiamine, Thiamin, Vitamin B1, Vitamin B-1.

Vitamine B1 (thiamine)

Thiamine is een in water oplosbaar vitamine B-complex. Thiamine kunnen we niet zelf aanmaken, daarom moet het worden geconsumeerd via voeding of als supplement worden ingenomen. Thiamine wordt vaak gebruikt in combinatie met andere B-vitamines in formuleringen van vitamine B-complexen. Vitamine B-complexen omvatten over het algemeen vitamine B1 (thiamine), vitamine B2 (riboflavine), vitamine B3 (niacine / niacinamide), vitamine B5 (pantotheenzuur), vitamine B6 (pyridoxine), vitamine B12 (cyanocobalamine) en foliumzuur. Sommige producten bevatten echter niet al deze ingrediënten en sommige bevatten andere nutriënten, zoals biotine, para-aminobenzoic acid (PABA), choline bitartrate en inositol.

Gebruik

Oraal wordt thiamine gebruikt voor thiaminedeficiëntiesyndromen, waaronder beriberi, perifere neuritis geassocieerd met pellagra en neuritis van zwangerschap. Het wordt gebruikt voor slechte eetlust, colitis ulcerosa, chronische diarree, GI-stoornissen, cerebellair syndroom, muggenspray, preventie van het westnijlvirus, diabetische neuropathie, aids, behoud van een positieve mentale houding, verbetering van leervermogen, hartziekte, alcoholisme, stress, veroudering, preventie van baarmoederhalskanker, prediabetes en progressie van nefropathie bij patiënten met type 2 diabetes. Thiamine wordt ook oraal gebruikt voor postherpetische neuralgie en jeuk, aften, immunodepressie, geheugenverlies waaronder de ziekte van Alzheimer, problemen met het gezichtsvermogen zoals cataract en glaucoom, bewegingsziekte en voor meer energie.

Veiligheid

WAARSCHIJNLIJK VEILIG: indien oraal en geschikt gebruikt. Thiamine wordt over het algemeen als niet-toxisch beschouwd; hoewel er zeldzame overgevoeligheidsreacties zijn opgetreden. Bij intraveneuze of intramusculaire en gepaste toediening. Injecteerbare thiamine is een door de FDA goedgekeurd recept.

ZWANGERSCHAP EN LACTATIE: WAARSCHIJNLIJK VEILIG: indien oraal en op de juiste manier gebruikt. De doses mogen de aanbevolen dagelijkse hoeveelheid (ADH) van 1,4 mg per dag niet overschrijden. Er is onvoldoende betrouwbare informatie beschikbaar over de veiligheid van het gebruik van grotere hoeveelheden tijdens de zwangerschap of borstvoeding.

Effectiviteit

Stofwisselingsziekten: thiamine oraal innemen helpt om tijdelijk metabole stoornissen te herstellen die verband houden met genetische ziekten zoals subacute necrotiserende encefalopathie (SNE, de ziekte van Leigh), ahornsiroopurineziekte (vertakte aminoacidopathie) en melkzuuracidose geassocieerd met pyruvaatcarboxylasedeficiëntie en hyperalaninemie.

Thiamine-tekort: thiamine oraal innemen helpt bij het voorkomen en behandelen van thiaminedeficiëntie syndromen, waaronder beriberi en perifere neuritis geassocieerd met pellagra of neuritis van zwangerschap. Thiaminedeficiëntie kan voorkomen bij mensen met malabsorptievoorwaarden zoals alcoholisme, cirrose en gastro-intestinale (GI) ziekten; bij mensen met onvoldoende inname door anorexia, misselijkheid en braken; en bij degenen met verhoogde vereisten, waaronder zwangerschap, verhoogde inname van koolhydraten, verhoogde lichamelijke activiteit, hyperthyreoïdie, infectie en leverziekte. Een tekort is echter zeldzaam met deze aandoeningen. Ouderen kunnen ook een verhoogd risico hebben op subklinische thiaminedeficiëntie.

Wernicke-Korsakoff-syndroom (WKS): parenterale toediening van thiamine lijkt het risico op het ontwikkelen van WKS te verlagen en de symptomen van WKS bij acute alcoholontwenning te verminderen. Van 30 tot 80% van de alcoholisten wordt vermoed dat ze thiaminedeficiëntie hebben. Er is geen optimale dosis voor de behandeling van WKS vastgesteld, maar een intramusculaire dosis van 200 mg kan effectiever zijn dan lagere doses.

Staar: bewijs uit bevolkingsonderzoek toont aan dat een hoge inname van thiamine via de voeding gepaard gaat met 40% lagere kans op nucleaire cataracten. Uit ander populatie-onderzoek blijkt dat een hogere inname van thiamine via de voeding gepaard gaat met een bescheiden verminderd risico op ouderdomsgerelateerde lensopacificatie.

Diabetische nefropathie: voorlopig klinisch onderzoek toont aan dat het drie maal daags innemen van een hoge dosis thiamine 100 mg gedurende 3 maanden de albumine-excretie van de urine bij patiënten met type 2 diabetes aanzienlijk verlaagt in vergelijking met placebo.

Dysmenorroe: voorlopig klinisch onderzoek suggereert dat het 100 dagen daags nemen van thiaminehydrochloride pijn elimineert bij 87% van de adolescente en volwassen vrouwen met matige tot ernstige primaire dysmenorroe. Uit ander voorlopig klinisch onderzoek blijkt dat het alleen nemen van thiamine of samen met visolie 500 mg per dag gedurende 2 maanden de pijnintensiteit en pijnduur matig vermindert in vergelijking met placebo bij adolescente vrouwen met dysmenorroe.

Dosering & gebruik

Volwassen

Oraal:

  • Algemeen: als voedingssupplement bij volwassenen wordt gewoonlijk 1-2 mg dagelijks gebruikt. De dagelijkse aanbevolen hoeveelheid (RDA) van thiamine is: baby's 0-6 maanden, 0,2 mg; Baby's 7-12 maanden, 0,3 mg; Kinderen 1-3 jaar, 0,5 mg; Kinderen van 4-8 jaar, 0,6 mg; Mannen 9-13 jaar, 0,9 mg; Mannen van 14 jaar en ouder, 1,2 mg; Vrouwen 9-13 jaar, 0,9 mg; Vrouwen 14-18 jaar, 1 mg; Vrouwen ouder dan 18 jaar, 1,1 mg; Zwangere vrouwen, 1,4 mg; en vrouwen die borstvoeding geven, 1,5 mg.
  • Cataract: thiamine 10 mg per dag is gebruikt.
  • Diabetische nefropathie: thiamine 100 mg driemaal per dag gedurende 3 maanden is gebruikt.
  • Dysmenorroe: thiamine 100 mg alleen of samen met visolie 500 mg wordt dagelijks gedurende 2-3 maanden gebruikt.
  • Verminderde glucosetolerantie (prediabetes): Thiamine 100 mg driemaal daags gedurende 6 weken werd gebruikt.
  • Metabole stoornissen: thiamine 10-20 mg per dag wordt aanbevolen, hoewel 600-4000 mg dagelijks in verdeelde doses nodig kan zijn voor de ziekte van Leigh.
  • Thiaminedeficiëntie: de gebruikelijke dosis thiamine is 5-30 mg per dag in een enkele dosis of verdeeld over een maand. De typische dosis voor ernstige tekortkomingen kan oplopen tot 300 mg per dag.

Bijwerkingen

Algemeen: gewoonlijk wordt thiamine goed verdragen. In zeldzame gevallen kan het dermatitis en andere overgevoeligheidsreacties veroorzaken. Parenteraal kan thiamine gevoelens van warmte, tintelingen, pruritus, pijn, urticaria, zwakte, zweten, misselijkheid, rusteloosheid, benauwdheid, angio-oedeem, ademnood, cyanose, longoedeem, gastro-intestinale bloedingen, voorbijgaande vasodilatatie, hypotensie en vasculaire instorting veroorzaken.

Interactie

Medicijnen

Geen bijwerkingen bekend.

Kruiden en supplementen

ARECA: Areca (betel) noten verminderen de thiamine-activiteit, waarschijnlijk door chemische inactivatie. Chronisch, regelmatig kauwen van betelnoten kan bijdragen aan thiaminedeficiëntie.

HORSETAIL: Paardenstaart (Equisetum) bevat een thiaminase-achtige samenstelling die thiamine in de maag kan vernietigen en theoretisch symptomatische thiaminedeficiëntie kan veroorzaken. De Canadese overheid eist dat equisetum-bevattende producten worden gecertificeerd vrij van thiaminase-activiteit. Vermijd het gebruik van dit kruid bij mensen met een verhoogd risico op thiaminedeficiëntie.

Voedsel

KOFFIE, THEE: polyfenolen, zoals tannines, in koffie en thee kunnen reageren met thiamine, het omzetten in een niet-absorbeerbare en inactieve vorm. Bewijs van thiaminedeficiëntie is gevonden in een landelijke Thaise bevolking die grote hoeveelheden thee (> 1 liter per dag) consumeert of gefermenteerde theebladeren chronisch kauwt. Dit effect is echter niet gevonden in de westerse bevolking, ondanks de reguliere theeconsumptie. Het is niet waarschijnlijk dat de interactie klinisch significant is, vooral wanneer het dieet voldoende is in thiamine en ook ascorbinezuur, wat de reactie tussen thiamine en polyfenolen kan voorkomen.

SEAFOOD: rauwe zoetwatervis en schaaldieren bevatten thiaminase-enzymen die thiamine vernietigen. Regelmatige inname van rauwe vis of schaaldieren kan bijdragen aan thiaminedeficiëntie. De enzymen worden vernietigd door te koken. Daarom heeft consumptie van gekookte schaal- en schelpdieren geen invloed op de thiaminespiegels.

Lab testen

SERUM THEOPHYLLINE: grote hoeveelheden thiamine kunnen de spectrofotometrische bepaling van serumtheofyllineconcentraties door Schack en Waxler verstoren.

URIC-zuur: thiamine kan vals-positieve resultaten in de fosfowolframaat-methode veroorzaken voor de bepaling van urinezuur.

UROBILINOGEN: thiamine kan bij de urine-vlektest vals-positieve resultaten met Ehrlich's reagens voor urobilinogeen veroorzaken.

Ziektes

ALCOHOLISME, CIRRHOSE: thiaminedeficiëntie wordt vaak geassocieerd met alcoholisme en cirrose. Alcoholisten hebben vaak een laag thiamieniveau als gevolg van een verminderde inname, verminderde absorptie en verminderde opslag van in water oplosbare vitaminen. Thiaminedeficiëntie lijkt ook bij te dragen aan alcoholische neuropathie.

KRITIEKE ZIEKTE: patiënten die ernstig ziek zijn, bijvoorbeeld chirurgische patiënten, lijken een risico te lopen op thiaminedeficiëntie. Thiaminesuppletie kan nodig zijn bij deze patiënten.

HEMODIALYSE: patiënten die hemodialyse ondergaan, lopen risico op thiaminedeficiëntie. Thiaminesuppletie kan nodig zijn bij deze patiënten.

MALABSORPTIE SYNDROMEN: thiamine-absorptie is verminderd in slechtabsorberende omstandigheden.

Werkingsmechanisme

Algemeen: thiamine is een in water oplosbare vitamine B, voorheen bekend als vitamine B1 of aneurine. Dieetbronnen van thiamine omvatten rundvlees, biergist, peulvruchten (bonen, linzen), noten, haver, varkensvlees, rijst, zaden, tarwe, volkoren granen en gist. Thiamine wordt ook aangetroffen in fruit (zoals sinaasappels), melk en melkproducten. In geïndustrialiseerde landen worden voedingsmiddelen gemaakt met witte rijst of witte bloem vaak verrijkt met thiamine omdat het meeste van de natuurlijk voorkomende thiamine verloren gaat tijdens het verfijningsproces.

Thiaminedeficiëntie leidt tot verminderde transketolase-activiteit in erytrocyten en verhoogde pyruvinezuurconcentratie in het bloed. Pyruvinezuur wordt omgezet in melkzuur. Daarom kan lactaatacidose ook voorkomen bij patiënten met thiaminedeficiëntie. Bij de ziekte van Crohn zijn verlaagde serumthiaminespiegels gemeld.

Anti-diabetische effecten: thiamine is nodig voor het metabolisme van koolhydraten. Het combineert met adenosinetrifosfaat (ATP) om thiaminedifosfaat te vormen, een co-enzym in het koolhydraatmetabolisme, waarbij de decarboxylatie van pyrodruivenzuur en alfa-ketoglutaarzuur optreedt. Dit co-enzym is ook een onderdeel van transketolatiereacties. Thiamine is ook een co-enzym bij het gebruik van pentose in de hexose monofosfaat-shunt.

Voorlopige gegevens van dieren suggereren dat thiaminedeficiëntie bij diabetici de ontwikkeling van diabetische nefropathie kan verergeren. Bij diabetische nefropathie wordt gedacht dat disfunctie van glomerulaire endotheelcellen, podocyten en tubulaire epitheelcellen kan worden omgekeerd door de plasmaconcentratie van thiamine te verhogen. Dit zou de glomerulaire en tubulaire structuur en functie en vasculaire ontsteking kunnen verbeteren, waardoor de albumine-excretie van de urine wordt verminderd.

Carcinogene effecten: thiamine activeert het transketolase-enzym dat vervolgens de synthese van nucleïnezuur-ribose en de proliferatie van kankercellen kan bevorderen. Het is onduidelijk of de inname van thiamine beperkt moet worden bij sommige kankerpatiënten.

Cardiovasculaire effecten: ernstige thiaminedeficiëntie kan een specifiek type hartfalen veroorzaken dat natte beriberi wordt genoemd. Beriberi wordt gekenmerkt door anorexia, buikpijn, constipatie, perifere neurologische veranderingen, slaapstoornissen, slecht geheugen en cardiovasculaire symptomen, waaronder dyspneu, oedeem, palpitaties, vasodilatatie, warme ledematen en hoog output hartfalen. Beriberi kan worden omgekeerd door suppletie met thiamine.

Thiamine kan ook gunstig zijn voor andere vormen van hartfalen. Thiaminedeficiëntie kan optreden als gevolg van cardiomyopathie, hartfalen en medicijnen die gewoonlijk worden toegediend aan patiënten met hartfalen.

Sommige onderzoeken tonen aan dat thiamine endotheel-afhankelijke vasodilatatie (EDV) kan verbeteren bij gezonde, prediabetische en diabetische patiënten die op hun beurt cardiovasculaire complicaties kunnen voorkomen. Ander klinisch onderzoek toont aan dat thiamine 100 mg driemaal daags gedurende 6 maanden resulteert in milde dalingen van de diastolische bloeddruk vanaf baseline bij normotensieve patiënten met hyperglycemie.

Insectverdrijvend middel: er is interesse in het gebruik van thiamine en andere B-vitamines als afweermiddel voor muggen en andere insecten. De theorie is dat orale inname van thiamine een geur produceert die detecteerbaar is door muggen die hen afstoot. Er is echter geen betrouwbaar bewijs dat thiamine voor dit gebruik werkt.

Neurologische effecten: syndromen geassocieerd met thiaminedeficiëntie zijn beriberi en Wernicke-Korsakoff-syndroom. Het syndroom van Wernicke-Korsakoff wordt gekenmerkt door verwarring, afonie, ataxie, nystagmus, oftalmoplegie en coma. Het wordt vaak geassocieerd met chronisch alcoholisme. Bij alcoholisme treedt thiaminedeficiëntie op als gevolg van een verminderde inname, verminderde absorptie en verminderde opslag van thiamine. Ethanol verlaagt ook de fosforylering van thiamine, waardoor de omzetting ervan tot de actieve vorm wordt verminderd. Thiamine kan ook betrokken zijn bij neuromusculaire transmissie.

Bovenstaande monografie is geschreven aan de hand van de onderstaande referenties.

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