Beriberi or beri-beri is a deficiency disease caused by an insufficient intake of thiamine. Thiamine is vitamin B1, which is essential for the body. It is triggered by improper or a deficient diet, persistent alcoholism and, in rare cases, a congenital form of beriberi.
What is beriberi?
Beriberi has been known as a classic deficiency disease for several centuries. Vitamin B1 is an indispensable component of the human diet. Thiamine is needed for the conversion of carbohydrates and sugars. It supports the energy supply of the metabolism. As soon as not enough thiamine is supplied, one of the various forms of beriberi can develop. Known are the two main groups of wet beriberi and the dry variant. In wet beriberi, the cardiovascular system and internal organs are affected. In dry beriberi, on the other hand, the disease manifests itself through failures of the nervous system. A special form is Wernicke-Korsakow syndrome as a result of long-term alcoholism. As with many deficiency diseases, the symptoms of beriberi can be treated and almost always completely cured by administering high doses of thiamine. Only if the damage is too advanced can permanent damage be expected in beriberi as well.
Causes
Beriberi always occurs when the diet is deficient in vitamin B1 or thiamine cannot be converted by the body. The vitamin is required for nerve cells and glucose metabolism. If a deficiency occurs, failures of the nervous system or dysfunction of internal organs follow. The introduction of husked and polished rice led to an increased incidence of beriberi in parts of Asia. Economically weaker sections of the population there live on a one-sided diet of rice. Industrial processing removes the husk containing thiamine and the vitamin deficiency causes beriberi. Alcoholics often suffer from the special form of beriberi because alcohol makes it difficult to absorb thiamine. Infants fed exclusively on breast milk may then develop beriberi if the mother herself is deficient in vitamin B1.
Symptoms, complaints, and signs
Fatigue, irritability, memory disturbances, or sleep disturbances, along with nausea, vomiting, loss of appetite, abdominal pain, or loss of body weight, are possible initial, still nonspecific symptoms of beriberi. Severe thiamine deficiency is associated with symptoms that indicate serious physical changes. These relate predominantly to tissues and muscles, nerves and brain, and the heart. Indications of abnormalities of muscles and nerves may include cramps or pain in the legs, as well as a tingling sensation in the toes, burning of the feet, especially during the night. Weakening muscles, muscle paralysis or atrophy, a gradual breakdown of muscle tissue, are also possible serious symptoms of severe thiamine deficiency. Changes in the heart caused by beriberi lead to fluid accumulation in the body. Resulting edema in the legs or congestion in the lungs may indicate the presence of a thiamine deficiency state. Severe changes in the brain may be indicated by states of confusion, memory loss, especially related to recent events, as well as difficulty with voluntary eye movements or eye paralysis. Infants as young as three to four weeks of age whose nursing mothers are affected by thiamine deficiency may show an absence of certain reflexes and, to some degree, loss of voice.
Diagnosis and course
Diagnosis of beriberi is not without problems because of the variety of symptoms. In addition, in Western industrialized nations, the occurrence of muscular and nervous disorders, memory disorders, or heart disease is rather rarely thought to be the result of malnutrition. The attending physician first takes a detailed medical history and questions the exact dietary habits of the affected person. Beriberi as Wernicke-Korsakow syndrome in severe alcoholics is more often recognized, because the occurring memory disorders and brain diseases can be significant. There are severe heart problems, swelling of internal organs and edema, depending on the form of beriberi. In dry beriberi, the gait deteriorates, the coordination of the extremities decreases.The ability to speak is impaired, memory disorders and clouding of consciousness can be observed. Convulsions may also occur with beriberi.
Complications
The deficiency disease beriberi always results from an inadequate supply of thiamine or vitamin B1 to the body metabolism. Equal effects can result from increased body demand or a metabolic disorder that prevents the body from using vitamin B1 in an adequate form. In the case of persistently insufficient intake of the vitamin, initially mild, unspecific and, in the further course, serious health complications set in. In dry beriberi, the nervous system is mainly affected. In addition to muscle weakness and muscle degeneration, the CNS is particularly affected. The ability to concentrate, short-term memory and speech are conspicuously reduced, and apathy and impaired consciousness occur. Immediately life-threatening complications occur in the wet or moist form of beriberi. Predominantly, the heart and circulation are initially affected. Increasing heart failure provokes secondary complications such as edema and respiratory problems. In cases of persistent undersupply of thiamine, severe forms of progression have also been reported, leading to heart failure and thus death. Another serious form of the disease is Wernicke’s encephalopathy, a complication of which leads to edematous fluid accumulation in the brain with corresponding consequences. As a rule, complications and problems in the autonomic nervous system arise, affecting hypotonia, speech disorders, sleep disorders, regulation of heat balance and much more. As long as the threshold of irreversibility is not exceeded, the symptoms and complications regress independently as soon as sufficient availability of vitamin B1 is ensured.
When should you see a doctor?
Beriberi can usually be cured easily and without late complications by sufficient administration of thiamine (vitamnin B1). However, diagnosis is not always easy. In the case of congenital forms of beriberi, a doctor must always be consulted. As a rule, regular examinations are necessary. Even if lifestyle is the cause of beriberi, over-the-counter vitamin preparations should not simply be consumed. A diagnosis by a physician is important in any case, since many of the symptoms can also be caused by other diseases, especially other deficiencies. A physician can also identify and treat other deficiencies that often occur together with vitamin B1 deficiency. High-risk groups should be sure to see a doctor if beriberi is suspected. Risk groups include people who eat a highly unbalanced diet, regularly follow reduction diets, or suffer from an eating disorder. Severe alcohol abuse also increases the risk of beriberi. In infants who are breastfed, vitamin B1 deficiency is always likely if the breastfeeding woman herself does not have an adequate supply of thiamine. In infants and young children, self-medication alone should not be undertaken under any circumstances, but a physician should be consulted, since developmental disorders can be expected if the supply is inadequate.
Treatment and therapy
Depending on the severity of the symptoms of beriberi, administration of concentrated vitamin B1 in tablet form is sufficient. This treatment can be performed on an outpatient basis with regular medical observation of the patient. If the symptoms of beriberi are already more severe, the patient is admitted to hospital and treated with high doses of vitamins in the form of infusions. In most cases, the symptoms quickly disappear when thiamine is administered. Only if the disease is more advanced does beriberi cause permanent damage. These often consist of heart disease and insufficient performance of the internal organs. Supportive therapy with medication is necessary. In the case of damage to motor function, physiotherapy together with vitamin administration can heal the movement impairment more quickly. Treatment of beriberi in alcoholics is problematic. Often considerable damage to memory remains. Those affected are predominantly impaired in the area of short-term memory. They still require permanent care and support in addition to withdrawal therapy.
Outlook and prognosis
In many cases, beriberi disease can be treated relatively well.This is especially true when the disease occurs due to an incorrect or insufficient diet. In this case, vitamin B1 can be reabsorbed by a healthy diet or by taking supplements, so that the symptoms also disappear. If beriberi is not treated, most of those affected suffer from severe abdominal pain, fatigue and also depression or inner restlessness. The symptoms do not disappear on their own if the disease is not treated. Disturbances of memory or concentration may occur. If the illness is triggered by very high alcohol consumption, the affected person is in most cases dependent on withdrawal, which can also be carried out in a closed clinic. Clinical treatment may also be necessary for eating disorders. If the disease is congenital, patients are permanently dependent on taking supplements. However, this completely relieves and limits the symptoms, so that there is no reduced life expectancy or reduced quality of life of the affected person.
Prevention
Prevention of beriberi is not problematic as long as the necessary foods are also available. A balanced diet that includes unprocessed foods such as whole grain rice, beans, or animal dairy products is already sufficient. Otherwise, beriberi can be prevented by vitamin tablets. Regardless of the reasons that led to beriberi symptoms, affected people usually continue to require observation. One reason is possible health damage that has occurred as a result of thiamine deficiency. Another reason is to monitor nutritional and vitamin status. It must be ensured that they permanently eliminate causes of thiamine deficiency.
Follow-up
Thiamine deficiencies are more common in civilization-developed societies in recent times than in the past. It may also just be that vitamin deficiency disorders are more frequently diagnosed correctly. Poor vitamin supply in chronic alcoholism requires not only withdrawal treatment but also monitoring for possible organ damage. Alcoholic relapse is also a risk. That being said, there is often poor nutritional status in chronic alcoholics. However, the extent to which a medical professional can actually monitor and provide follow-up care to affected individuals often depends on their willingness to cooperate. Follow-up care is also required for the surgical insertion of gastric bands and similar measures after an obesity finding. Here, it is not only possible to develop beriberi symptoms due to one-sided malnutrition. The affected persons can also suffer from other secondary symptoms after the surgical intervention. They must be monitored quarterly and require regular medical appointments. Thanks to metabolic or possible surgical complications, such patients must attend follow-up visits for the rest of their lives.
Here’s what you can do yourself
The typical symptoms of vitamin B1 deficiency disease beriberi can be quite distinct, but they are nonspecific, so that it is not always immediately recognized that it is a B1 vitaminosis and thus a deficiency of thiamine – as vitamin B1 is also called. If beriberi and thus thiamine deficiency is recognized as the cause at an early stage for the symptoms that occur, self-help consists of a change in diet to foods that contain as much vitamin B1 as possible. If preferably peeled and polished rice is on the menu, this should be replaced by unpeeled rice, because the thiamine is in the husk of the rice grain and retains its physiological abilities even after cooking and is absorbed by the body. In addition to unhulled rice, wheat germ, whole grains, and oatmeal and peas, as well as pork and heart, are also suppliers of thiamine. This means that even affected vegetarians and even vegans usually need not fear beriberi unless their main diet consists mainly of husked rice. If vitamin B1 intake is ensured via a change in diet, the typical motor and cognitive symptoms and problems disappear by themselves. If beriberi has only been diagnosed at an advanced stage, some of the symptoms remain irreversible and become chronic.This is especially true for sufferers who are additionally addicted to alcohol.
