beriberi

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Related to Thiamine deficiency: beriberi, Wernicke's encephalopathy

Beriberi

 

Definition

Beriberi is a disease caused by a deficiency of thiamine (vitamin B1) 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 it has on its victims. It is common in parts of southeast Asia, where white rice is the main food. In the United States, beriberi is primarily seen in people with chronic alcoholism.

Description

Beriberi puzzled medical experts for years as it ravaged people of all ages in Asia. Doctors 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.

Causes and symptoms

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.

Diagnosis

A physical examination will reveal many of the early symptoms of beriberi, such as fatigue, irritation, nausea, constipation, and poor memory, but the deficiency may be difficult to identify. Information about the individual's diet and general health is also needed.

Key terms

B vitamins — This family of vitamins consists of thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin, folic acid (B9), and cobalamin (B12). 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.
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.
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.

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.

Alternative treatment

Alternative treatments for beriberi deal first with correcting the thiamine deficiency. As in conventional treatments, alternative treatments for beriberi stress a diet rich in foods that provide thiamine and other B vitamins, such as brown rice, whole grains, raw fruits and vegetables, legumes, seeds, nuts, and yogurt. Drinking more than one glass of liquid with a meal should be avoided, since this may wash out the vitamins before they can be absorbed by the body. Thiamine should be taken daily, with the dose depending on the severity of the disease. Additional supplements of B vitamins, a multivitamin 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.

Prognosis

Beriberi is fatal if not treated and the longer the deficiency exists, the sicker the person becomes. Most of the symptoms can be reversed and full recovery is possible when thiamine levels are returned to normal and maintained with a balanced diet and vitamin supplements as needed.

Prevention

A balanced diet containing all essential nutrients will prevent a thiamine 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.

Dietary requirements

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

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 Phillipines.
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.

Resources

Periodicals

Ryan, Ruth, et al. "Beriberi Unexpected." Psychosomatics May-June 1997: 191-294.

beriberi

 [ber″e-ber´e]
an endemic form of polyneuritis due to an unbalanced diet, chiefly a lack of thiamine (vitamin B1). It is more common in areas where refined rice is the main staple in the diet; however, improved refining processes, enrichment and fortification of grain and cereal products, and improved dietary habits have now decreased its incidence. In the United States, mild forms sometimes occur in persons on extremely restricted diets. Alcoholics, who tend to decrease food intake drastically during periods of drinking, may show signs of beriberi. See also alcoholism.

ber·i·ber·i

, beri beri (ber'ē-ber'ē),
A specific nutritional deficiency syndrome occurring in endemic form in eastern and southern Asia, sporadically in other parts of the world without reference to climate, and sometimes in alcoholic patients, resulting mainly from a dietary deficiency of thiamin; the "dry" form is characterized by a painful polyneuropathy that involves both large and small somatic nerve fibers, as well as autonomic nerve fibers, the initial symptom is burning feet, and later symptoms consist of painful parasthesias in the distal upper limbs as well, weakness and atrophy of the feet and hands, and distal atrophic skin and hair loss; the "wet" form is characterized by edema resulting from a high output form of heart failure, but usually there is evidence of a coexisting polyneuropathy as well.
See also: nutritional polyneuropathy.
Synonym(s): endemic neuritis
[Singhalese, extreme weakness]

beriberi

(bĕr′ē-bĕr′ē)
n.
A disease caused by a deficiency of thiamine, characterized by neurological symptoms, cardiovascular abnormalities, and edema, and occurring chiefly in individuals whose diet consists largely of polished rice.

ber·i·ber·i

(ber'ē-ber'ē)
A nutritional deficiency syndrome occurring in endemic form in eastern and southern Asia, sporadically in other parts of the world, and sometimes in alcoholic patients, resulting mainly from a dietary deficiency of thiamine; characterized by painful polyneuritis, diarrhea, weight loss, fatigue, poor memory, and edema resulting from a high-output form of heart failure.
Synonym(s): endemic neuritis.
[Singhalese, extreme weakness]

ber·i·ber·i

(ber'ē-ber'ē)
A specific nutritional deficiency syndrome occurring in endemic form in eastern and southern Asia, sporadically in other parts of the world without reference to climate, and sometimes in alcoholic patients, resulting mainly from a dietary deficiency of thiamin.
[Singhalese, extreme weakness]
References in periodicals archive ?
Furthermore, a positive correlation was found between thiamine deficiency and dyslipidaemia in diabetics.
Because thiamine and the thiamine-using enzymes are present in all cells of the body, it would be plausible that inadequate thiamine affects all organ systems; however, the cells of the nervous system and heart seem particularly sensitive to the effects of thiamine deficiency. Therefore, the resulting impairment in the functioning of the thiamine-using enzymes primarily affects the cardiovascular and nervous systems.
Comment: The results of this study suggest that obesity is a risk factor for clinical thiamine deficiency. However, these findings should be considered preliminary, in that a low whole-blood thiamine concentration does not necessarily indicate clinically important thiamine deficiency, and the improvement attributed to thiamine therapy could have been due to a placebo effect, spontaneous remission, or other concurrent treatments.
This is an appropriate analogy, since relative thiamine deficiency is easily induced by an excess of simple carbohydrate.
Wernicke and Korsakoff syndrome is the best neurological complication of alcoholism with thiamine deficiency.
Thiamine deficiency: poor nutrition, malabsorption in the digestive tract, and liver failure present in patients with alcohol dependence determine the onset of a severe condition: Wernicke's encephalopathy (WE), which, if left untreated, can become chronic and give rise to Korsakoff's syndrome (KS) (Horton et al., 2015).
Alagau is a herb found only in the Phillippines and has been found to be effective in treating this thiamine deficiency disease.
(31) A thiamine deficiency triggers a cascade of events that lead to oxidative stress and inflammation, which are major contributors to Alzheimer's, Parkinson's, and other dementia-producing disorders.
(1967) observed that increasing level of thiamine than 1.2 mg/kg diet had no effect on growth performance, but formulating diets containing 0.8 mg thiamine/kg impaired growth performance, whereas feeding them diets prepared to contain 0.4 mg thiamine/kg resulted in exhibition of thiamine deficiency signs and 100% mortality rate.
Early signs of thiamine deficiency include decreased appetite, salivation , vomiting, failure to grow, and weight loss.
Cats fed diets low in thiamine for several weeks may be at risk for developing a thiamine deficiency. Thiamine is essential for cats.
In addition, there are several factors that lead to the development of thiamine deficiency, which is caused by decreased availability, impaired utilization and accelerated use.