Beriberi – Risk Factors, Manifestations, and Diagnosis.

What is Beriberi?

Beriberi is a syndrome characterized by a group of symptoms exhibited by people who are deficient in Vitamin B1, also known as thiamine. Therefore, it usually afflicts malnourished individuals’ particularly in underdeveloped countries. Two kinds of beriberi are well known. Wet beriberi leads to cardiovascular dysfunction while dry beriberi results in necrosis and wearing down of the nervous system. If left untreated, it may cause cardiac failure, necrosis of nerves, or Wernicke’s Korsakoff syndrome.

Types of Beriberi

There are mainly three types of Beriberi:

• Wet Beriberi which affects the heart of a person as it involves the cardiovascular system and can prove to be fatal sometimes due to weakening of the capillary walls and heart failure.

 

• Dry Beriberi affects the nervous system of the body and is sometimes referred to as endemic neuritis which causes paralysis and other conditions.

 

• Infantile Beriberi occurs to the children of Thiamine deficient mothers who are breast feeding them. It usually occurs in the first year of the child’s life and if not treated immediately can prove to be fatal.

History behind the discovery of Beriberi and its symptoms

Christiaan Eijkman (1858-1930) discovered that not all diseases were caused by microorganisms like bacteria and viruses, but that some were due to dietary deficiencies, particularly deficiencies of certain vitamins. Born in the Netherlands in 1858, Eijkman received his medical degree from the University of Amsterdam in 1883, then went to Germany to study under the famous bacteriologist, Heinrich Robert Koch (1843-1910). Encouraged by Koch, Eijkman joined a commission sent to the Dutch East Indies (now Indonesia) in 1887 to investigate the disease beriberi and begin the work that was to make him famous.

Eijkman had discovered a dietary deficiency disease. At first, he did not fully understand the meaning of his findings, assuming that there must be a toxin (poison) in rice grains that could be neutralized by something in the hulls. But others would quickly clarify his results.

A younger colleague, Gerrit Grijns, took over the nutrition studies when an illness forced Eijkman to go home in 1896. In 1901 Grijns proposed that beriberi was caused not by germs, but by the lack of some natural substance present in rice hulls and other foods (this substance turned out to be thiamine, a vitamin.

Over the next decade, a number of investigators—most notably, England’s Frederick Gowland Hopkins (1861-1947)—came to similar conclusions about a number of diseases and a new era in medicine was launched. Eijkman, whose work served as the basis for the modern theory of vitamins, shared the Nobel Prize in medicine with Hopkins in 1929.

Prevalence

• The prevalence of beriberi is much higher in East Asian countries because of the consumption of milled rice. Thiamine is contained in the outer coat of rice, and polishing destroys it. In the same countries, the custom of eating raw fish further increases the potential for deficiency.
• Breastfed infants whose mothers have thiamine deficiency develop an infantile form of beriberi.
• The same socioeconomic factors that yield beriberi in the West do so with much greater prevalence in East Asia. A study done in Indonesia revealed the prevalence of thiamine deficiency among low-income families to be as high as 66%. A study conducted in a group of Karen women from a refugee camp on the Thailand-Burma border revealed that up to 58% of these women were thiamine deficient 3 months postpartum, despite what appeared to be adequate dietary thiamine supplements.
• Outbreaks have been described in prisons, drug rehabilitation centers, rural, agrarian communities, and in ships kept out at sea too long.
• A familial form of thiamine deficiency with mitochondrial myopathy has been described in Japan.

Causes and risk factors of Beriberi

These factors may cause thiamine deficiency, as well.

• 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
• Hyperthyroidism (overactive thyroid gland)
• Extreme nausea and vomiting in pregnancy
• Bariatric surgery
• Fad Diets
• Malnutrition
• AIDS
• Prolonged diarrhea or use of diuretics (medication that makes you urinate more)
• Undergoing kidney dialysis
• Feeding mothers, lacking the vitamin may pass on the deficiency to their young ones via breast feeding.

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
• Swollen lower legs

Dry beriberi symptoms include:

• Decreased muscle function, particularly in the lower legs
• Tingling or loss of feeling in the feet and hands
• Pain
• Mental confusion
• Difficulty speaking
• Vomiting
• Involuntary eye movement
• Paralysis

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:

• Confusion
• Memory loss
• 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
• Hallucinations

Complications of Beriberi

The following systems are most affected by beriberi:

• Gastrointestinal system. When the cells of the smooth muscles in the digestive system and glands do not get enough energy from glucose, they are unable to produce more glucose from the normal digestion of food. There is a loss of appetite, indigestion, severe constipation, and a lack of hydrochloric acid in the stomach.
• Nervous System. Glucose is essential for the central nervous system to function normally. Early deficiency symptoms are fatigue, irritability, and poor memory. If the deficiency continues, there is damage to the peripheral nerves that causes loss of sensation and muscle weakness, which is 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 (foot drop).
• Cardiovascular system. There is a rapid heartbeat and sweating. Eventually the heart muscle weakens. Because the smooth muscle in the blood vessels is affected, the arteries and veins relax, causing swelling, known as edema, in the legs.
• Musculoskeletal system. There is widespread muscle pain caused by the lack of TPP in the muscle tissue.
• Infants who are breastfed by a thiamine-deficient mother usually develop symptoms of deficiency between the second and fourth month of life. They are pale, restless, unable to sleep, prone to diarrhea, and have muscle wasting and edema in their arms and legs. They have a characteristic, sometimes silent, cry and develop heart failure and nerve damage.

Exams and Tests

A physical examination may show signs of congestive heart failure, including:

Difficulty breathing with neck veins that stick out

• Enlarged heart
• Fluid in the lungs
• Rapid heartbeat
• Swelling in both lower legs

A person with late-stage beriberi may be confused or have memory loss and delusions. The person may be less able to sense vibrations. A neurological exam may show signs of:

• Changes in the walk
• Coordination problems
• Decreased reflexes
• Drooping of the eyelids

The following tests may be done:

• Blood tests to measure the amount of thiamine in the blood
• Urine tests to see if thiamine is passing through the urine

Treatments & home remedies

The goal of treatment is to replace the thiamine your body is lacking. This is done with thiamine supplements. Thiamine supplements are given through a shot (injection) or taken by mouth. The intake of Vitamin B1-rich pills prove to be highly advantageous and are observed to lend relief to the patient within a short span of time. Except for in extreme cases, a proper diet comprising of more thiamine than needed must be supplied while the body is in the recovering state. Excess thiamine is never harmful to the body.

Brown Rice

Brown or husked rice is considered to be the best source of thiamine, and therefore should be made a part of our regular diet. Try avoiding polished or dehusked rice as they lack vitamin B1. A healthy diet that is rich in rice can always help you from contracting beriberi.

Rice Bran

This is the best of all the known home remedies for beriberi. It has been practiced for hundreds of years. Rice is boiled in an excess of water and the water containing the rice extract is drained and collected in a vessel. This water can is drinkable, and has significant quantities of Vitamin B1.

 

Legumes

Most of the legumes, seeds and nuts contain thiamine in their outer covering. These can be used frequently, if not regularly.

Milk

Milk is a rich source of vitamins and other mineral nutrients and should be consumed on regular basis.

Whole Grain Brown Bread

Grains that contains outer layer are very rich in thiamine. Feeding individuals with thiamine-rich brown bread can also contribute to the overall vitamin content in the body.

Alagau

Alagau is a herb found only in the Philippines and has been found to be effective in treating this thiamine deficiency disease. Individuals with thiamine-rich brown bread can also contribute to the overall vitamin content in the body.

Prevention of Beriberi

• Avoid Drinking After Meals: Vitamin B1, being a water soluble compound, tends to get drained out of the body if excess liquid is drunk after meals.
• Avoid Fish: Shellfish, clams, mussels, shrimps, and raw tissue of animals contains an enzyme thiaminase which causes a breakdown of thiamine. Therefore, consumption of fish must be avoided in order to retain the existing vitamin B1 in the body.

To prevent beriberi, eat a healthy, balanced diet that includes foods rich in Vitamin B1 (thiamine). These include:

• Beans and legumes
• Seeds
• Meat
• Fish
• Whole grains
• Nuts
• Dairy
• 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 B1 vitamin deficiency.