Beriberi (ˈbe-ree-ˈbe-ree) is a disease caused by vitamin B1 deficiency, also known as thiamine deficiency. It is a nutritional disorder in which the body does not have enough thiamine (vitamin B1).
Beriberi is divided into four categories as follows. The first three are historical and the fourth, gastrointestinal beriberi, was recognized in 2004:
Wet beriberi specially affects the heart and circulatory system. In extreme cases, wet beriberi can cause heart failure.
Dry beriberi specially affects the peripheral nervous system and can lead to decreased muscle strength and eventually, muscle paralysis.
Infantile beriberi affects the children of malnourished mothers.
Gastrointestinal beriberi affects the digestive system and other bodily systems.
Beriberi can be life-threatening if it isn’t treated.
Historically, beriberi has been common in regions where polished or white rice forms a major part of the diet, which has its husk removed to extend its shelf life and palatability but has the side effect of removing the primary source of thiamine. It was not known until the end of the 19th century that polishing rice was associated with beriberi.
If you have access to foods rich in thiamine, your chances of developing beriberi are low. Today, beriberi mostly occurs in people with an alcohol use disorder.
What are the Symptoms of Beriberi?
The symptoms of beriberi vary depending on the type.
Wet beriberi symptoms include:
shortness of breath during physical activity
waking up short of breath
rapid heart rate
peripheral oedema (swelling of lower legs)
Dry beriberi symptoms include:
decreased muscle function, particularly in the lower legs
tingling or loss of feeling in the feet and hands
involuntary eye movement
Infantile beriberi usually occurs between two and six months of age in children whose mothers have inadequate thiamine intake. In the acute form, the baby develops dyspnoea (difficult or laboured respiration) and cyanosis (a bluish discolouration of the skin and mucous membranes) and soon dies of heart failure. These symptoms may be described in infantile beriberi:
hoarseness, where the child makes moves to moan but emits no sound or just faint moans caused by nerve paralysis
weight loss, becoming thinner and then marasmic as the disease progresses
alterations of the cardiovascular system, especially tachycardia (rapid heart rate)
convulsions occasionally observed in the terminal stages
Gastrointestinal beriberi causes abdominal pain. Gastrointestinal beriberi is characterized by:
In extreme cases, beriberi is associated with Wernicke-Korsakoff syndrome. Wernicke encephalopathy and Korsakoff syndrome are two forms of brain damage caused by thiamine deficiency.
Wernicke encephalopathy damages regions of the brain called the thalamus and hypothalamus. This condition can cause:
loss of muscle coordination
visual problems such as rapid eye movement and double vision
Korsakoff syndrome is the result of permanent damage to the region of the brain where memories form. It can cause:
loss of memory
inability to form new memories
When to Contact a Medical Professional
Call your health care provider if:
You feel your family's diet is inadequate or poorly balanced
You or your children have any symptoms of beriberi
What Causes Beriberi?
The main cause of beriberi is a diet low in thiamine. The disease is very rare in regions with access to vitamin-enriched foods, such as certain breakfast cereals and breads. Beriberi is most common in regions of the world where the diet includes un-enriched, processed white rice, which only has a tenth of the amount of thiamine as brown rice.
Who is at Risk?
Other factors may cause thiamine deficiency, as well. These include:
Alcohol abuse, which can make it hard for your body to absorb and store thiamine.
Genetic beriberi, a rare condition that prevents the body from absorbing thiamine. This condition is passed down through families.
Hyperthyroidism (overactive thyroid gland).
Extreme nausea and vomiting in pregnancy.
Prolonged diarrhoea or use of diuretics (medication that makes you urinate more).
Undergoing kidney dialysis.
Breastfeeding mothers need daily thiamine in their diet. Infants drinking breast milk or formula low in thiamine are at risk for thiamine deficiency.
How is Beriberi Diagnosed?
You will need a series of medical tests to determine whether or not you have beriberi. Blood and urine tests will measure the levels of thiamine in your body. If your body has trouble absorbing thiamine, you will have a low concentration of thiamine in your blood and a high concentration in your urine.
Doctors will also perform a neurological exam to look for lack of coordination, difficulty walking, droopy eyelids, and weak reflexes. People with later stages of beriberi will show memory loss, confusion, or delusions.
A physical exam will alert your doctor to any heart problems.
How is Beriberi Treated?
Beriberi is easily treated with thiamine supplements. Your doctor may prescribe a thiamine shot or pill. For severe cases, a healthcare professional will administer intravenous thiamine.
Your progress will be monitored with follow-up blood tests to see how well your body is absorbing the vitamin.
Complications may include:
Congestive heart failure
How to Prevent Beriberi
To prevent beriberi, eat a healthy, balanced diet that includes foods rich in thiamine.
beans and legumes
certain vegetables, such as asparagus, acorn squash, brussels sprouts, spinach, and beet greens
breakfast cereals that are enriched with thiamine
Cooking or processing any of the foods listed above decreases their thiamine content.
If you give your infant formula, you should also check that it contains enough thiamine.
Always be sure to purchase infant formula from a reliable source.
Limiting alcohol consumption will reduce your risk of developing beriberi. Anyone who abuses alcohol should be checked routinely for a B-1 vitamin deficiency.
What is the Prognosis for Someone with Beriberi?
Untreated, beriberi can be fatal. If beriberi is caught and treated early, the outlook is good. Nerve and heart damage from beriberi is usually reversible when it’s caught in the early stages. Recovery is often quick once you begin treatment.
If beriberi progresses to Wernicke-Korsakoff syndrome, the outlook is poor. While treatment can control symptoms of Wernicke encephalopathy, brain damage from Korsakoff syndrome is often permanent.
Maintaining a healthy, balanced diet is important for your health. Talk to your doctor if you think you are showing signs of a thiamine deficiency or if you need advice on how to get the nutrients you need.
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