Intestine transforming into a nerve pathway, symbolizing the connection between gut health and nerve function.

Beriberi's Hidden Threat: How Gut Issues Can Lead to Vitamin B1 Deficiency

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"Unexplained weakness and balance problems? An 11-year-old's case highlights the unexpected link between gut health, colectomy, and a rare vitamin deficiency."

Beriberi, a disease caused by vitamin B1 (thiamine) deficiency, is uncommon in developed countries but remains a concern, particularly in those with malnutrition. While it often manifests with neurological (dry beriberi) or cardiovascular symptoms (wet beriberi), its presentation can be complex.

This article delves into an unusual case: an 11-year-old girl with a history of total colectomy who developed dry beriberi. Her symptoms, which included gait ataxia (unsteady walking) and muscle weakness, emerged following a cholecystectomy (gallbladder removal) performed to address chronic abdominal pain.

This case underscores the critical link between gut health and nutrient absorption, and it serves as a reminder to consider vitamin deficiencies in patients with gastrointestinal issues. We will explore the girl's diagnosis, treatment, and the underlying factors that contributed to her condition. This is to bring insights into recognizing and managing thiamine deficiency in vulnerable individuals.

The Gut-Vitamin Connection: Why Colectomy Can Increase Risk

Intestine transforming into a nerve pathway, symbolizing the connection between gut health and nerve function.

Thiamine is a crucial nutrient that is vital for both energy production and nerve function. It plays a key role in:

The oxidative pathway: Thiamine helps convert pyruvate (a product of glucose breakdown) into acetyl CoA, which fuels energy production in cells. This is especially critical for the nervous system and heart.

Non-oxidative metabolism: Thiamine supports the pentose phosphate pathway, essential for creating fatty acids, maintaining the myelin sheath (protective covering of nerves), and ensuring proper nerve function.
Thiamine is mainly absorbed in the upper part of the small intestine (jejunum). Malnutrition significantly reduces its absorption. Alcohol consumption can also interfere with thiamine absorption.
The body's thiamine stores are limited, and it has a short half-life. Therefore, consistent intake is essential.

Given its crucial roles and limited storage, thiamine deficiency can quickly lead to beriberi. In individuals who have undergone a colectomy (removal of the colon), the risk of thiamine deficiency can be elevated due to altered gut function and potential malabsorption. In this case, several factors likely converged to trigger the girl's beriberi:

Key Takeaways: Recognizing and Addressing Thiamine Deficiency

This case highlights the importance of considering thiamine deficiency in patients with gastrointestinal issues, particularly those who have undergone colectomy. Look for subtle neurological signs and symptoms and address those proactively.

Maintaining adequate thiamine levels is critical for overall health, especially for individuals with compromised gut function. If you or someone you know experiences unexplained weakness, balance problems, or gastrointestinal symptoms, consult with a healthcare professional to assess thiamine status.

By raising awareness of this potential complication, we can improve early diagnosis and treatment, helping those at risk avoid the serious consequences of thiamine deficiency.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/omcr/omy091, Alternate LINK

Title: Beriberi Disease In An 11-Year-Old Girl With Total Colectomy

Subject: Infectious Diseases

Journal: Oxford Medical Case Reports

Publisher: Oxford University Press (OUP)

Authors: Shafee Salloum, Ajay Goenka, Adam Mezoff

Published: 2018-10-31

Everything You Need To Know

What exactly is beriberi, and how is it related to thiamine?

Beriberi is caused by a deficiency in thiamine, also known as vitamin B1. This deficiency impacts crucial bodily functions because thiamine plays a vital role in energy production and nerve function. Specifically, thiamine is essential for the oxidative pathway, which converts pyruvate into acetyl CoA for energy, and for non-oxidative metabolism, which supports fatty acid creation and nerve function.

How can a colectomy increase the risk of developing beriberi?

The removal of the colon, known as a colectomy, can increase the risk of thiamine deficiency, potentially leading to beriberi. This is because thiamine is primarily absorbed in the upper part of the small intestine (jejunum), and altered gut function post-colectomy can impair this absorption process. When absorption is compromised, the body can't effectively utilize thiamine, especially since thiamine storage in the body is limited.

What are the key symptoms of beriberi that one should be aware of, particularly after gastrointestinal surgery?

Symptoms of beriberi can vary, but they often include neurological issues like gait ataxia (unsteady walking) and muscle weakness. These symptoms are associated with dry beriberi. Cardiovascular symptoms, characteristic of wet beriberi, can also manifest. It's important to consider these possibilities, particularly in individuals with gastrointestinal issues or a history of colectomy, where nutrient absorption might be compromised.

Where and how does the body absorb thiamine, and what factors can interfere with this process?

Thiamine is absorbed mainly in the jejunum, which is the upper part of the small intestine. Absorption can be significantly reduced by malnutrition and alcohol consumption. After a colectomy, the altered gut function can lead to malabsorption. Thiamine has a short half-life and limited storage in the body, regular intake through diet or supplements is crucial to maintain adequate levels and prevent deficiency.

Besides colectomy, what other gastrointestinal issues might increase the risk of thiamine deficiency and beriberi, and what are the implications for managing these conditions?

While the case highlights the risks associated with colectomy and subsequent thiamine deficiency leading to beriberi, it also brings broader implications for individuals with gastrointestinal issues. Any condition that impairs nutrient absorption—such as Crohn's disease, celiac disease, or even severe cases of irritable bowel syndrome (IBS)—could potentially lead to similar deficiencies. Proactive monitoring, dietary adjustments, and supplementation may be necessary to prevent complications related to vitamin deficiencies in vulnerable populations.