Beriberi

Overview

Vitamins are essential nutrients that our bodies need in order to remain healthy and function normally. Vitamins are necessary for metabolism, growth, and maintenance of tissues. We obtain these essential nutrients through naturally occurring sources by way of our diet but sometimes we may need supplements to make up for any deficiencies in the diet. Either way, it is important to ensure that your body receives the vitamins it needs because when it does not, it can suffer and develop the disease. Beriberi is an example of a disease caused by nutritional deficiency, and this article will explain how exactly it arises, how it affects the body and how it can be prevented or treated.

What Is Beriberi?

Beriberi is a disease that is caused by the deficiency of vitamin B1 in the body. This vitamin is also known as thiamine. The biologically active form of thiamine is a substance known as thiamine pyrophosphate.

Along with other B-complex vitamins, thiamine helps your body conduct metabolism of carbohydrates, fats, and protein. This metabolism enables the cells to obtain the energy that they need for their survival and essential functions. A critical shortage of vitamin B1 in the diet can affect the cardiovascular and nervous systems. This can be fatal. However, it is possible to successfully treat the condition. Beriberi can also arise as a consequence of chronic alcoholism.

Who Is At Risk Of Developing Beriberi?

Thiamine can be obtained from naturally occurring sources including both animal and plant sources. For example, foods such as pork, beef, fish, eggs, dairy, potatoes, nuts and legumes contain thiamine. Brown rice contains thiamine but when it is polished, it loses most of its natural vitamin content. Hence, beriberi tends to occur more often among populations where white rice constitutes a dietary staple. However, this is not the only possible cause for the disease.

Since thiamine is a water-soluble vitamin, it is absorbed in the small intestine during the process of digestion. Any condition that interferes with this processor generally impairs the process of absorption, can potentially give rise to beriberi.

There are 3 broad scenarios in which thiamine deficiency may arise:

• A lack of thiamine in the diet.
• Alternatively, the person may be consuming foods that deplete or are detrimental to thiamine. Undergoing procedures such as dialysis can also deplete thiamine content in the body.
• The body may be unable to absorb the thiamine it needs, although the diet may provide the right quantities of the vitamin.
• Yet another possibility is that under certain conditions, such as pregnancy or during lactation, the body needs higher quantities of thiamine. When the diet is not adjusted to cater to this need, the person may develop a deficiency.

A fuller list of specific causes appears in the list below:

• Dietary insufficiency.
• Excessive intake of foods, like tea and coffee, that contain anti-thiamine factor.
• Intake of foods containing sulfite.
• The condition can also be caused by genetic factors.
• Excessive consumption of alcohol.
• Those suffering from Crohn’s disease, an inflammatory bowel disorder, are at risk of developing beriberi.
• Patients undergoing dialysis are also at risk.
• Patients who have undergone a gastric bypass surgery.
• Those receiving intravenous fluids that contain high quantities of glucose.
• Those suffering from hyperthyroidism.
• Having eating disorders such as anorexia can lead to severe nutritional deficiencies such as beriberi.
• Starvation.
• Refeeding syndrome.
• Celiac disease.
• Folate deficiency.
• Severe liver disease.
• Patients with chronic diarrhoea.
• Pregnant and lactating women.
• Infants who are fed with a formula that does not provide adequate amounts of thiamine. Similarly, an infant that feeds on breast milk can also develop a deficiency of thiamine if the mother herself is deficient.

Symptoms

Initially, lack of vitamin B1 in the body gives rise to symptoms resembling anorexia. As the condition worsens, thiamine deficiency eventually gives rise to beriberi. Often, the onset of the disease is insidious. In other words, it proceeds gradually although this masks the fact that it can have very grave consequences for the health. Alternatively, in some cases, onset can be sudden and life-threatening.

Some typical symptoms are:

• A headache.
• Fatigue.
• Nausea.
• Shortness of breath.
• Increase in heart rate.
• Difficulty in breathing.
• Irritability.
• Abdominal discomfort.
• Peripheral neuropathy. The patient may experience tingling or abnormal sensations in the limbs.
• Peripheral edema or swelling, usually in the lower legs.
• Vomiting.
• Inability to control the movement of the eyes.
• Double vision.
• Poor reflexes.
• Mental confusion.
• Paralysis.

What Are The Different Forms Of Beriberi?

There are two main modes of disease progression, namely, the dry and wet forms of beriberi. These are discussed below in brief.

• Wet Beriberi: This has an adverse impact on cardiovascular function. The blood vessels dilate, causing swelling and forcing the heart to beat faster. Eventually, this can lead to heart failure.
• Dry Beriberi: In such instances, the neurological function becomes impaired. As a result, the patient experiences pain and abnormal sensations such as tingling, often in the peripheral regions. He or she may start to experience difficulties in speaking and the reflexes tend to weaken. Damage to the nerves could be permanent and irreversible if not attended to in time.

Some patients also show a mixed form of the disease, exhibiting signs of both types.

• Yet another form of beriberi is known as the Infantile type. As we have seen above, if the nursing mother herself is deficient in thiamine, this will deprive the infant of the essential compound. As a result, the baby may develop symptoms such as difficulty in breathing, diarrhea, vomiting, swelling and bluish discoloration of the skin. Eventually, the infant may die of heart failure.

What Are The Possible Complications?

Thiamine deficiency can cause the patient to develop critical conditions known as Korsakoff syndrome and Wernicke encephalopathy. Doctors believe that once the patient has progressed to this stage, it is difficult to make a full recovery even with sound treatment. Wernicke encephalopathy and Korsakoff syndrome both involve severe damage to certain sections of the brain. The former results in damage to the thymus and hypothalamus, both of which are critical in regulating essential faculties such as muscle coordination and homeostasis. Patients with Korsakoff syndrome may suffer hallucinations and lose the ability to form new memories and access existing ones as a result of damage to the area of the brain concerned with memory.

In severe cases or where prompt treatment is not available, the patient could die within a few days of onset of symptoms.

How Is Beriberi Diagnosed And Treated?

In order to address the disease and treat it, it is first necessary to make a diagnosis of the underlying cause or causes. If these can be resolved, then the beriberi can also be addressed. As initial symptoms might be non-specific, the condition may not be easy to identify. The process of diagnosis may involve the following steps:

• Physical examination.
• Medical history, paying particular attention to diet, lifestyle, and habits such as alcoholism.
• Blood tests.
• Neurological tests to assess nervous function.

If you have been diagnosed with beriberi and the cause is a lack of vitamin B1 in your diet, you will mostly like be prescribed dietary supplements. Your doctor will advise you as to the dose most appropriate for you. If, however, the underlying cause is a condition other than dietary insufficiency, treatment will aim to address that first in order to also resolve beriberi.

The main aim of treating beriberi is to increase the thiamine levels in the patient’s body. This includes thiamine medicines either taken as oral supplements or injected into the patient’s body. The patient’s blood and urine are monitored regularly in order to access whether or not the treatment method is effective or not.  While the treatment of beriberi is relatively simple, if left untreated, beriberi could be fatal.  Death usually occurs due to cardiac failure or neurological malfunction. The most effective method of preventing beriberi is consuming a diet rich in vitamin B1 and refraining from substance abuse of alcohol. Breastfeeding mothers should take special care in maintaining proper levels of thiamine in their systems.

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