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DESCRIPTION
Beriberi is a disease caused by a deficiency of the B vitamins, particularly vitamin B-1 (thiamine) that affects many systems of the body, including the muscles, heart, nerves, and digestive system. Beriberi literally means "I can't, I can't" in Singhalese, which reflects the crippling effect this nutritional deficiency has on its victim. This disease occurs mainly in the Far East, where the diet consists principally of polished rice, which does not supply sufficient thiamine. Cases of beriberi that occur in the United States are usually associated with chronic alcoholism, hypothyroidism, infections, pregnancy, and/or stress.
Beriberi was a puzzle for medical practitioners for years as it ravaged people of all ages in Asia. Health care providers thought it was caused by something in food. Not until the early 1900s did scientists discover that rice bran, the outer covering that was removed to create the polished white rice preferred by Asians, actually contained something that prevented the disease. Thiamine was the first vitamin identified. In the 1920s, extracts of rice polishings were used to treat the disease.
In adults, there are different forms of beriberi, classified according to the body systems most affected. Dry beriberi involves the nervous system; 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." This condition 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, also 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.
Infantile beriberi is seen in breastfed infants of thiamine-deficient mothers, who live 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.
KEY TERMINOLOGY
B Vitamins: This family of vitamins consists of thiamine (B), riboflavin (B), niacin (B), pantothenic acid (B), pyridoxine (B), biotin, folic acid (B), and cobalamin (B). They are interdependent and involved in converting glucose to energy.
Coenzyme: A substance needed by enzymes to produce many of the reactions in energy and protein metabolism in the body.
Edema: An excess accumulation of fluid in the cells and tissues.
Enzyme: A protein that acts as a catalyst to produce chemical changes in other substances without being changed themselves.
Metabolism: All the physical and chemical changes that take place within an organism.
Peripheral Neuropathy: A disease affecting the portion of the nervous system outside the brain and spinal chord. One or more nerves can be involved, causing sensory loss, muscle weakness and shrinkage, and decreased reflexes.
Thiamine Pyrophosphate (TPP): The coenzyme containing thiamine that is essential in converting glucose to energy.
SYMPTOMS
Symptoms of beriberi in children can include:
- Impaired muscle growth.
- Muscle wasting & disease (myopathy).
- Mental confusion.
- Convulsions.
- Gastrointestinal problems.
- Nausea.
- Vomiting.
- Constipation and diarrhea.
In adults, the symptoms also include:
- Mental confusion and speech difficulties.
- Wernicke's encephalopathy. If a person with Wernicke's encephalopathy receives thiamine replacement, language problems, unusual eye movements and walking difficulties may subside, but may be replaced by Korsakoff's syndrome, which includes retrograde amnesia (memory loss), impaired ability to learn, and confabulation (making up stories to explain behavior that have little relation to reality).
- Strange eye movements (nystagmus).
- Diarrhea.
- Edema.
- Fatigue.
- Weight loss.
- Complaints of symmetric tingling or burning pain in the extremities. Numbness in the extremities. Difficulty walking (ataxia). Nerve damage than can lead to paralysis (peripheral neuritis). The neurological symptoms are caused by degeneration of the nerve fibers and their insulation (myelin sheath).
- Coma.
- Heart failure. This is the most common cause of death in people with beriberi. Heart failure symptoms include shortness of breath with exertion (dyspnea), symmetric swelling of the lower legs, and awakening at night short of breath (paroxysmal nocturnal dyspnea).
- Death.
There are two kinds of beriberi: dry and wet.
Dry beriberi (and Wernicke-Korsakoff syndrome) results in the loss of strength and of some feeling in the limbs due to nerve degeneration. Symptoms of dry beriberi include:
- Pain.
- Tingling.
- Loss of feeling (sensation) in hands and feet.
- Muscle damage with loss of muscle function or paralysis of the lower legs.
- Vomiting.
- Strange eye movements (nystagmus).
- Mental confusion/speech difficulties.
- Difficulty walking.
- Coma.
- Death.
Wet beriberi is caused by accumulated fluid in the limbs (edema) and in the abdomen (ascites) because of a heart malfunction, increased heart rate (tachycardia), enlarged heart related to congestive heart failure, lung congestion, nerve degeneration is commonly present as well. Symptoms of wet beriberi include:
- Swelling of the lower legs.
- Increased heart rate.
- Lung congestion.
- Enlarged heart related to congestive heart failure.
- Shortness of breath with activity.
- Awakening at night short of breath.
CAUSES OF THIAMINE DEFICIENCY
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, and breastfeeding, can increase the body's thiamine requirements and lead to symptoms of deficiency. Extended periods of diarrhea or chronic liver disease can result in the body's inability to maintain normal levels of many nutrients, including thiamine. Other persons at risk are patients with kidney failure on dialysis and those with severe digestive problems who are unable to absorb nutrients. Alcoholics are susceptible because they may substitute alcohol for food and their frequent intake of alcohol decreases the body's ability to absorb thiamine.
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 (footdrop).
- 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.
PERSONS AT RISK
Beriberi now occurs primarily in persons who abuse and are chronic alcoholics, because drinking heavily can lead to malnutrition and poor absorption and storage of thiamine. This is the cause of "wet brain" or Wernicke-Korsakoff syndrome, which is alcohol-related brain damage affecting language and thinking.
Beriberi can also occur in breast-fed infants when the mother has an inadequate intake of thiamine and it can also affect infants fed unusual formulas with inadequate thiamine supplements.
Others at risk for beriberi include people undergoing dialysis, those receiving high doses of diuretics, and people in developing countries with limited diets who consume milled (white) rice.
TREATMENT
DIAGNOSTIC TESTS
Physical examination will reveal many of the early symptoms of beriberi, such as fatigue, irritation, nausea, and poor memory, but the deficiency may be difficult to identify or may be mistaken for other disorders. Information about the individual's diet and general health are needed to help properly identify this deficiency. A physical examination may show signs of congestive heart failure, including symmetrically swollen lower legs, fluid in the lungs, and elevated neck veins with labored breathing, a rapid heartbeat, and an enlarged heart.
The person with late-stage beriberi may be confused or have memory loss and delusions. Neurological examination may show a loss of vibratory sensation (the person is less able to sense vibration), decreased reflexes, loss of coordination, gait changes (ataxia), nystagmus, drooping of the eyelids (ptosis) and inability to move the eye outwards (opthalmoplegia).
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. The urine can be collected for 24 hours 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. Tests may include:
- Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity.
- Measurement of urinary thiamine excretion.
- Clinical response to administered thiamine (symptoms improve after the person is given thiamine supplements).
An electroencephalogram (EEG), which measures electrical activity in the brain, may be done to rule out other causes of neurologic changes. Observing improvements in the patient after giving thiamine supplements will also confirm the diagnosis.
MEDICAL 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 (intramuscular) or in a solution that goes into a vein (intravenously) 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.
The cardiovascular symptoms of wet beriberi can respond to treatment within a few hours if they are not too severe. 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; 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.
Excess thiamine is excreted by the body in the urine, and negative reactions to too much thiamine are rare. Thiamine is unstable in alkali solutions, so it should not be taken with antacids or barbiturates.
THIAMINE INFORMATION
THIAMINE GENERAL INFORMATION
Thiamine is necessary for proper muscle tone of the stomach, intestines, and heart. It is also an antioxidant that helps protects the body from the degenerative effects of aging, alcohol consumption, and smoking. The richest natural sources of Thiamine are brown rice, egg yolks, fish, legumes, liver, peanuts, peas, pork, poultry, rice bran, wheat germ, and whole grains; however, it can also be found in asparagus, Brewer's yeast, broccoli, Brussels sprouts, dulse, kelp most nuts, oatmeal, plums, dried prunes, raisins, spirulina, and watercress.
THIAMINE USES & SCIENTIFIC EVIDENCE
Having adequate amounts of Thiamine, enhances cognitive activity and brain function. Thiamine also helps stimulate overall growth, energy, and normal appetite. This vitamin improves circulation and aids in the formation of blood. It also produces hydrochloric acid, which is necessary for proper digestion.
THIAMINE DOSAGE INFORMATION
To take as a daily nutritional supplement, read and follow product label directions. If taken for a nutritional deficiency, follow your health care provider's directions for dosage recommendations.
THIAMINE SAFETY & INTERACTION INFORMATION
There are no known safety issues associated with Thiamine when taken in the recommended doses. Taking antibiotics, phenytoin (Dilantin), sulfa drugs, and oral contraceptives may decrease Thiamine levels in the body. Heavy alcohol or caffeine consumption can decrease Thiamine levels as well. High carbohydrate diets increase the need for Thiamine.
MoonDragon's Health & Wellness: Nutrition Basics - Vitamin B-1 (Thiamine)
HOLISTIC RECOMMENDATIONS
Administration of thiamine can reverse the deficiency and symptoms should improve rapidly. However, with severe deficiency, some symptoms may be irreversible. Therapeutic doses of other water-soluble vitamins should be taken with the thiamine. Thiamine should be taken daily, with the dose dependent on the severity of the disease. Additional supplements of B vitamins, a multi-vitamin and mineral complex and vitamin C are also recommended. Other alternative therapies may help relieve the person's symptoms after the thiamine deficiency is corrected.
Adequate dietary intake of thiamine will prevent beriberi. Include brown rice, legumes, raw fruits and vegetables, seeds and nuts, whole grains, and yogurt in your daily diet. These foods are rich in B vitamins, particularly thiamine.
Do not drink liquids with meals. Drinking more than one glass of liquid with a meal should be avoided. This dilutes digestive juices and leads to many of the B vitamins being washed away before they can be absorbed by the body.
Nursing mothers should insure that their diet is adequate in all vitamins and pay special attention to the B vitamins, which includes thiamine.
If your baby is on formula, be sure that the infant formula contains thiamine.
People who drink heavily should try to cut down or quit and supplement their diets with B vitamins to insure intake of thiamine.
A balanced diet containing all essential nutrients will prevent a thiamin deficiency and the development of beriberi. People who consume large quantities of junk food like soda, pretzels, chips, candy, and high carbohydrate foods made with unenriched flours may be deficient in thiamine and other vital nutrients. They may need to take vitamin supplements and should improve their diets.
NUTRITIONAL SUPPLEMENTS
DIETARY REQUIREMENTS FOR THIAMINE
The body's requirements for thiamine are tied to carbohydrate metabolism and expressed in terms of total intake of calories. The current recommended dietary allowances (RDA) are 0.5 mg for every 1000 calories, with a minimum daily intake of 1 mg even for those who eat fewer than 2,000 calories in a day. The RDA for children and teenagers is the same as for adults: 1.4 mg daily for males over age eleven, and 1.1 mg for females. During pregnancy, an increase to 1.5 mg daily is needed. Because of increased energy needs and the secretion of thiamine in breast milk, breast feeding mothers need 1.5 mg every day. In infants, 0.4 mg is advised.
FOOD SOURCES OF THIAMINE
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, as in white rice, white breads, and some cereals, the lower the thiamine. Many 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 Philippines.
Like all B vitamins, thiamine is water soluble, which means it is easily dissolved in water. It will leach out during cooking in water and is destroyed by high heat and overcooking.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for persons over the age of 18 years. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12, use 1/2 the recommended dose, and for a child under 6 years old, use 1/4 the recommended amount.
HerbalRemedies: Thiamine / Thiamin / Vitamin B-1 Information
HerbalRemedies: Thiamine Supplements & Products
MEDICATIONS
Cardiovascular Beriberi (Shoshin Disease):
- Thiamine, IV, 50-100 mg daily. Plus Furosemide, 40-80 mg daily, According to severity. This if for heart failure with acidosis and/or peripheral neuropathy.
- Plus sodium bicarbonate 8.5%, titrated to pH response on a formula of bicarbonate needed (0.50 x weight (kg) x desired bicarbonate minus deficit). This is to correct acidosis. It needs to be monitored clinically and by pH determination.
- Followed with thiamine, orally administered, 100 mg 3 times daily for one month.
Wernicke's Encephalopathy & Peripheral Neuropathy:
- Thiamine, IV or IM, 50-100 mg daily until the patient is able to swallow.
- Thereafter, administer thiamine, orally, 50-100 mg daily for 3 to 6 months.
- Plus vitamin B complex, orally, 1-2 tablets 3 times daily for one month.
Wernicke's encephalopathy is an emergency thiamine deficiency. Deficiency is commonly associated with other vitamin deficiencies.
EXPECTED OUTCOME
Cardiac damage is usually reversible and is not permanent. Full recovery is expected after treatment. Untreated, beriberi is often fatal.
If acute heart failure has already occurred, the outlook is poor.
Nervous system damage is also reversible if caught early. If not, some symptoms such as memory loss may not be completely recovered with treatment.
If a patient with Wernicke's encephalopathy receives thiamine replacement, language problems, unusual eye movements, and walking difficulties may go away. However, Korsakoff syndrome (or Korsakoff psychosis) tends to develop as Wernicke's symptoms go away. Symptoms include memory loss, learning problems, and confabulation (making up stories about experiences or situations to cover gaps in memory).
COMPLICATIONS
Psychosis.
Coma.
Congestive heart failure.
Death.
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You have questions about beriberi and vitamin B deficiencies. Beriberi is extremely rare in the United States. However, if you feel your family's diet is inadequate or poorly balanced and you or your children have any of the described symptoms, call your health care provider.
If the disorder does not improve with treatment.
If you have any unexplained, unusual symptoms, or symptoms listed above for sensitive people. Some people may have allergic reactions to certain supplements or treatments.
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