Beriberi Disease

1.0What is Beriberi?

Beriberi is a disease caused by a deficiency of thiamine (Vitamin B1) — a vital nutrient that helps the body convert food into energy. Thiamine plays a crucial role in nerve function, muscle contraction, and heart health. When the body lacks thiamine for an extended period, the nervous and cardiovascular systems start to malfunction, leading to beriberi disease.

This condition was first identified in populations dependent on polished white rice, which lacks the nutrient-rich outer layer containing Vitamin B1. Today, beriberi is rare in developed nations but still appears in areas with poor nutrition, alcoholism, or malabsorption disorders.

The Role of Thiamine (Vitamin B1)

To understand Beriberi, one must understand the vitamin it lacks. Thiamine is responsible for:

• Energy Metabolism: Converting nutrients (carbohydrates) into energy.
• Nerve Function: Maintaining the myelin sheath that covers and protects nerves.
• Muscle Control: ensuring smooth muscle contraction and signal transmission.

2.0Causes of Beriberi

The Role of Vitamin B1 (Thiamine)

Vitamin B1, also known as thiamine, is a water-soluble vitamin essential for energy production and nerve function. It helps in the breakdown of carbohydrates into energy and supports the smooth functioning of the heart, muscles, and nervous system.

When thiamine intake is insufficient, the body’s cells cannot produce enough energy, leading to fatigue, nerve degeneration, and cardiovascular problems—the hallmark symptoms of beriberi.

Sources of Vitamin B1

Vitamin B1 is found naturally in a variety of foods, including:

• Whole grains (brown rice, wheat, oats)
• Legumes (lentils, beans)
• Nuts and seeds (sunflower seeds, peanuts)
• Lean meats (pork, liver)
• Green vegetables (spinach, broccoli)
• Fortified cereals and breads

A balanced diet with these foods helps prevent vitamin B1 deficiency.

Factors Leading to Vitamin B1 Deficiency

Several factors can lead to thiamine deficiency:

• Dietary deficiency due to polished rice or processed foods
• Alcoholism, which interferes with vitamin absorption
• Chronic diseases affecting the digestive system
• Prolonged fasting or malnutrition
• High carbohydrate intake without adequate vitamin B1

In developing countries, poverty and reliance on polished rice are the primary causes of beriberi

3.0Types of Beriberi

There are three main types of beriberi: dry, wet, and infantile.

Dry Beriberi

Dry beriberi primarily affects the nervous system. It results from long-term thiamine deficiency and leads to nerve degeneration and muscle wasting.
Common symptoms include:

• Tingling or numbness in hands and feet
• Muscle weakness and loss of coordination
• Difficulty walking
• Mental confusion or memory loss

Wet Beriberi

Wet beriberi affects the cardiovascular system, leading to heart and circulation problems.
Typical symptoms include:

• Shortness of breath
• Swelling (oedema) in legs and feet
• Rapid heartbeat
• Enlarged heart
• Fatigue and weakness

If untreated, wet beriberi can cause heart failure and may be life-threatening.

Infantile Beriberi

This type occurs in infants (0–6 months old), usually breastfed by mothers with thiamine deficiency.
Symptoms include:

• Difficulty breathing
• Persistent crying
• Vomiting
• Heart problems and failure to gain weight

Immediate treatment is essential to prevent serious complications in infants.

Gastrointestinal Beriberi

A less common but distinct form that affects the digestive system. It is often a precursor to other forms and is caused by the accumulation of lactate in the gut due to faulty metabolism.

Wernicke-Korsakoff Syndrome

Often considered a complication of severe Dry Beriberi or chronic alcoholism, this syndrome affects the central nervous system (brain).

• Wernicke’s Encephalopathy: Acute confusion, eye issues, and loss of coordination. Reversible with immediate treatment.
• Korsakoff’s Psychosis: Chronic, often irreversible memory loss and confabulation (making up memories) that develops if Wernicke's is not treated.

4.0Symptoms of Beriberi

Symptoms vary significantly depending on the type of Beriberi present.

Symptoms of Wet Beriberi

• Oedema: Swelling in the lower legs, feet, and ankles.
• Tachycardia: Rapid heart rate, even at rest.
• Dyspnea: Shortness of breath, particularly during physical activity or waking up at night breathless.
• Fatigue: Extreme tiredness due to inefficient heart function.
• Distended Neck Veins: Visible veins in the neck due to increased pressure in the heart.

Symptoms of Dry Beriberi

• Peripheral Neuropathy: Numbness, tingling, or a "burning" sensation in the hands and feet.
• Muscle Atrophy: Wasting away of muscle mass, particularly in the legs.
• Gait Abnormalities: Difficulty walking, often described as a "high-stepping" gait or dragging feet.
• Loss of Reflexes: Reduced or absent knee-jerk response.
• Paralysis: In severe cases, partial paralysis of the lower limbs.
• Pain: Muscle tenderness and cramps.

Symptoms of Infantile Beriberi

• Aphonia: The infant may cry silently or have a hoarse cry (due to nerve paralysis in the vocal cords).
• Cyanosis: Blue tint to the skin due to lack of oxygen.
• Vomiting and Diarrhoea: Gastrointestinal distress.
• Cardiomegaly: Enlarged heart detectable by examination

5.0Diagnosis of Beriberi

Doctors diagnose beriberi based on physical symptoms, dietary history, and blood or urine tests to measure thiamine levels.
Other diagnostic methods include:

• Electrocardiogram (ECG) – to detect heart abnormalities
• Nerve conduction tests – for assessing nerve function
• Urinary thiamine excretion test – measures how much thiamine the body releases

A positive response to thiamine supplementation often confirms the diagnosis.

6.0Treatment of Beriberi

Treatment focuses on replacing thiamine and addressing underlying causes.

• Thiamine injections or oral supplements are given immediately.
• Patients show improvement within days if treated early.
• A balanced diet with thiamine-rich foods—like whole grains, legumes, nuts, seeds, pork, and fortified cereals—is essential.
• Avoiding alcohol facilitates nutrient absorption.

For severe cases (especially wet beriberi), hospitalisation may be necessary to manage cardiac or respiratory complications.

7.0Prevention of Beriberi

Preventing beriberi involves maintaining a thiamine-rich diet and promoting nutritional awareness.

• Include foods like brown rice, beans, peas, fish, milk, eggs, and sunflower seeds in your daily meals.
• Pregnant and breastfeeding women should ensure adequate Vitamin B1 intake.
• Government programs and WHO initiatives have helped reduce the incidence of beriberi through food fortification and public health education.