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Beriberi (Thiamine Deficiency) (B1 Deficiency) Print E-mail

Dr. Kennedy Beriberi puzzled medical experts for years as it ravaged people of all ages in Asia. Doctors thought it was caused by something in food. In the early 1900s scientists discovered that the outer covering that was removed to create the polished white rice actually contained something that prevented the disease. Thus thiamine was the first vitamin identified. In the 1920s, extracts of rice polishings were used to treat beriberi. Beriberi literally means "I can't, I can't" in Singhalese, reflecting the crippling effect it has on its victims. It is is caused by a deficiency of B1 (thiamine) and affects muscles, heart, nerves, and digestive system. Beriberi is common in parts of southeast Asia where white rice is the main food. In the United States, beriberi is primarily seen in people with chronic alcoholism.

There are two forms of beriberi classified according to the body systems most affected. Dry beriberi involves the nervous system and wet beriberi affects the heart and circulation. Both types usually occur in the same patient, with one set of symptoms predominating. A less common form of cardiovascular or wet beriberi, is known as "shoshin." which involves a rapid appearance of symptoms and acute heart failure. It is highly fatal and is known to cause sudden death in young migrant laborers in Asia whose diet consists of white rice. Cerebral beriberi, known as Wernicke-Korsakoff syndrome, usually occurs in chronic alcoholics and affects the central nervous system (brain and spinal cord). It can be caused by a situation that aggravates a chronic thiamine deficiency, like an alcoholic binge or severe vomiting and is seen not uncommonly in emergency rooms. Infantile beriberi is seen in breastfed infants of thiamine-deficient mothers, who usually are living in developing nations. Although severe beriberi is uncommon in the United States, less severe thiamine deficiencies do occur. About 25% of all alcoholics admitted to a hospital in the United States show some evidence of thiamine deficiency.

Causes and Symptoms

Thiamine is one of the B vitamins and plays an important role in energy metabolism and tissue building. It combines with phosphate to form the coenzyme thiamine pyrophosphate (TPP), which is essential in reactions that produce energy from glucose or that convert glucose to fat for storage in the tissues. When there is not enough thiamine in the diet, these basic energy functions are disturbed, leading to problems throughout the body. Special situations, such as an over-active metabolism, prolonged fever, pregnancy, breastfeeding, extended periods of diarrhea, chronic liver disease, kidney failure, severe digestive problems are unable to absorb nutrients are are thus at risk for thiamine deficiency. Alcoholics are susceptible because they may substitute alcohol for food and their frequent intake of alcohol decreases the body's ability to absorb thiamine.

There is a loss of appetite, indigestion, severe constipation, and a lack of hydrochloric acid in the stomach. There is fatigue, irritability, and poor memory. There can be damage to the peripheral nerves with loss of sensation and muscle weakness (called peripheral neuropathy). The legs are most affected. The toes feel numb and the feet have a burning sensation; the leg muscles become sore and the calf muscles cramp. The individual walks unsteadily and has difficulty getting up from a squatting position. Eventually, the muscles shrink (atrophy) and there is a loss of reflexes in the knees and feet; the feet may hang limp (footdrop). There is a rapid heartbeat and sweating and eventually the heart muscle weakens. Because the smooth muscle in the blood vessels is affected, the arteries and veins relax, causing edema, especially in the legs. There is widespread muscle pain caused by the lack of TPP in the muscle tissue.

Infants who are breastfed by a thiamine-deficient mother tend to develop symptoms of deficiency between the second and fourth month of life. They are pale, restless, unable to sleep, have to diarrhea, with muscle wasting and edema in their arms and legs. They have a characteristic, sometimes almost silent, cry and they develop heart failure and nerve damage.

Diagnosis

A history will reveal early symptoms of beriberi, such as fatigue, irritation, nausea, constipation, and poor memory, but the deficiency may be difficult to identify. Information about the individual's diet and general health is needed.

There are many biochemical tests based on thiamine metabolism or the functions of TPP that can detect a thiamine deficiency. Levels of thiamine can be measured in the blood and urine and will be reduced if there is a deficiency. 24 hour urine cllection alanlysis to measure the level of thiamine excreted. Another reliable test measures the effect of TPP on red blood cell activity since all forms of beriberi affect the metabolism of red blood cells.

Treatment

Treatment with thiamine reverses the deficiency in the body and relieves most of the symptoms. Severe thiamine deficiency is treated with high doses of thiamine given by injection into a muscle or into a vein for several days. Then smaller doses can be given either by injection or in pill form until the patient recovers. Usually there are other deficiencies in the B vitamins that will also need treatment. Heart failure may require additional treatment with diuretics that help eliminate excess fluid and with heart-strengthening drugs like digitalis. Recovery from peripheral neuropathy and other symptoms of dry beriberi may take longer and patients frequently become discouraged. They should stay active and physical therapy will also help in recovery. Infantile beriberi is treated by giving thiamine to both the infant and the breast feeding mother until levels are normal. In Wernicke-Korsakoff syndrome, thiamine should be given intravenously or by injection at first because the intestinal absorption of thiamine is probably impaired and the patient is very ill. Most of the symptoms will be relieved by treatment, though there may be residual memory loss. Alternative treatment

Prognosis

Beriberi is fatal if not treated and the longer the deficiency exists, the sicker the person becomes. Most of the symptoms can be reversed and full recovery is possible when thiamine levels are returned to normal and maintained with a balanced diet and vitamin supplements as needed.

Prevention

A balanced diet containing all essential nutrients will prevent a thiamine deficiency and the development of beriberi. People who consume large quantities of junk food need to take vitamin supplements and should improve their diets.

Food Sources

The best food sources of thiamine are lean pork, beef, liver, brewer's yeast, peas and beans, whole or enriched grains, and breads. The more refined the food, the lower the thiamine. Some food products are enriched with thiamine, along with riboflavin, niacin, and iron, to prevent dietary deficiency. During the milling process, rice is polished and all the vitamins in the exterior coating of bran are lost. Boiling the rice before husking preserves the vitamins by distributing them throughout the kernel. Food enrichment programs have eliminated beriberi in Japan and the Phillipines. Like all B vitamins, thiamine is water soluble, which means it is easily dissolved in water and thus not stored in the body, thus requiring sustained intake. It will leach out during cooking in water and is destroyed by high heat and overcooking.



The information in this article is not meant to be medical advice. Treatment for a medical condition should come at the recommendation of your personal physician.

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