Vitamins and Alcohol: Thiamin, Folate, Vitamin A and Liver Cautions

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If you drink heavily or are dependent on alcohol, two safety points come before any vitamin question. First, the NHS (UK) says it can be very dangerous to stop drinking suddenly if you are dependent, and to get medical help before you try to stop. [1] Second, severe withdrawal signs, which the NHS lists as including confusion and seizures, are an emergency; in the US call 911. [1] Confusion, poor coordination or vision changes in someone who drinks heavily can also signal Wernicke-Korsakoff syndrome (below) and need urgent medical care. [2]

Information only. Talk to a clinician or pharmacist before taking vitamins if you drink heavily or have liver disease.

What alcohol does to vitamin status

MedlinePlus says alcohol use is one of the major causes of nutritional deficiency in the United States, and that the most common deficiencies are of the B vitamins (B1, B6 and folic acid), which can cause anemia and nervous system problems. [3] Evidence label: established nutritional role / deficiency.

Thiamin (vitamin B1)

Thiamin deficiency in the US is most often seen in people who drink heavily, because alcohol makes it hard for the body to absorb thiamin from food. [4] Severe deficiency can cause Wernicke-Korsakoff syndrome, a brain disorder; MedlinePlus says lack of vitamin B1 is common in people with alcohol use disorder. [2] Treatment is medical: vitamin B1 is usually given by injection into a vein or muscle as soon as possible, and a nourishing diet helps but is not a substitute for stopping alcohol use. [2] MedlinePlus adds that if a heavy drinker cannot or will not quit, thiamine supplements and a good diet may reduce the chance of the condition, but the risk is not eliminated. [2] MedlinePlus knows of no poisoning linked to excessive thiamin intake. [4] See Beriberi and Wernicke encephalopathy and Thiamin.

Folate and B6

Folic acid and B6 are named among the common deficiencies with alcohol use. [3] Two cautions: the NHS says folic acid doses higher than 1 mg can mask the symptoms of vitamin B12 deficiency, which can eventually damage the nervous system if not treated. [5] And the NHS says taking 200 mg or more a day of vitamin B6 can cause loss of feeling in the arms and legs (peripheral neuropathy), sometimes permanent. [5] MedlinePlus says stopping alcohol use can prevent further damage to nerves, so new numbness or tingling needs medical assessment, not self-treatment. [2] See Folate vs folic acid vs methylfolate and Vitamin B6 toxicity.

Niacin

MedlinePlus lists liver damage among the effects of too much niacin and advises not to drink alcohol with niacin used for cholesterol, because of flushing. [9] The NHS also says long-term high doses of nicotinic acid could lead to liver damage. [5] See Niacin flush and safety.

Supplements during recovery

MedlinePlus says vitamin and mineral supplements may be helpful during recovery from substance use, and to take them if recommended by your health care provider. [3] Proper evidence not found for trials showing that vitamin supplements prevent alcohol-related liver damage: I searched MedlinePlus, NHS and NIAAA pages and the PubMed review above. Alcohol-related liver disease is a medical condition; see Vitamins and kidney or liver disease and Liver safety and supplements. In pregnancy, the NHS says to get help from your doctor or an alcohol support service if you are finding it hard to stop. [1]