beriberi

[ber-ee-ber-ee]

beriberi, deficiency disease occurring when the human body has insufficient amounts of thiamine (vitamin B₁). The deficiency may result from improper diet (e.g., ingestion of highly refined grains instead of the whole kernels), from poor absorption of thiamine (as in chronic diarrhea), from conditions which increase the vitamin requirements of the body (e.g., hyperthyroidism, pregnancy, fever), or from poor utilization (as in liver disease). In some instances (e.g., alcoholism) the deficiency arises from a combination of several or of all of these factors. Since thiamine is essential for the proper metabolism of carbohydrate and fat and for the normal functioning of enzymes and nervous tissue, the symptoms of the disorder are primarily those of neurological and gastrointestinal disturbances. In severe cases the heart becomes affected, and the nervous disorder may lead to paralysis and death. The disorder is rarely found in the West, occurring only among alcoholics and other groups who exist on grossly inadequate diets. It is a common malady in parts of Asia where the diet consists mainly of polished white rice. The usual treatment is administering dosages of thiamine.

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Licensed from Columbia University Press

beriberi

or vitamin B₁ deficiency

Nutritional disorder, with nerve and heart impairment, caused by thiamin deficiency. Its name is from the Sinhalese word for “extreme weakness.” Symptoms include fatigue, digestive problems, and limb numbness and weakness. Dry beriberi involves gradual long-nerve degeneration, with muscle atrophy and loss of reflexes. Wet beriberi is more acute, with edema from cardiac failure and poor circulation. Thiamin occurs widely in food but is lost in processing; a well-balanced diet high in unprocessed foods can prevent beriberi. In Western countries, chronic alcoholism is the most common cause.

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Encyclopedia Britannica, 2008. Encyclopedia Britannica Online.

Beriberi

Beriberi (pronounced Berry-berry) is a nervous system ailment caused by thiamine (vitamin B₁) deficiency. Thiamine is involved in the breakdown of energy molecules such as glucose. It is also found on the membranes of neurons. Symptoms of Beriberi include severe lethargy and fatigue, together with complications affecting the cardiovascular, nervous, muscular, and gastrointestinal systems.

Etymology

The origin of the word is from a Sinhalese phrase meaning "I cannot, I cannot", the word being doubled for emphasis.

Causes

Beriberi is caused by a lack of thiamine (vitamin B₁). Thiamine occurs naturally in unrefined cereals and fresh foods, particularly whole grain bread, fresh meat, legumes, green vegetables, fruit, and milk. Beriberi is therefore common in people whose diet excludes these particular types of nutrition.

Beriberi may be found in people whose diet consists mainly of polished white rice, which is very low in thiamine because the thiamine-bearing husk has been removed. It can also be seen in chronic alcoholics with an inadequate diet (Wernicke-Korsakoff syndrome), as well as being a rare side effect of gastric bypass surgery. If a baby is mainly fed on the milk of a mother who suffers from thiamine deficiency then that child may develop beriberi as well.

The disease was often found in Asian countries (especially in the 19th century and before), due to those countries' reliance on white rice as a staple food.

Symptoms and effects

Its symptoms include weight loss, emotional disturbances, impaired sensory perception (Wernicke's encephalopathy), weakness and pain in the limbs, and periods of irregular heart rate. Edema (swelling of bodily tissues) is common. In advanced cases, the disease may cause heart failure and death. It may also increase the amount of lactic acid and pyruvic acid within the blood.

Wet beriberi affects the heart; it is sometimes fatal, as it causes a combination of heart failure and weakening of the capillary walls, which causes the peripheral tissues to become edematous.

Dry beriberi causes wasting and partial paralysis resulting from damaged peripheral nerves. It is also referred to as endemic neuritis.

Treatment

Treatment for beriberi is with thiamine hydrochloride, either in tablet form or injection. A rapid and dramatic recovery within hours can be made when this is administered to patients, and their health can be improved within an hour of starting treatment. In emergency situations where concentrated thiamine supplements are unavailable, feeding the patient with a thiamine-rich diet (e.g. whole grain brown bread) will lead to recovery, though at a much slower rate. Additionally, administering glucose will provide the patient with a temporary boost, while their body recovers.

History

In Asia where polished white rice was the common staple food of the middle class, beriberi resulting from lack of vitamin B was endemic. In 1884, Takaki Kanehiro, a British-trained Japanese medical doctor of the Japanese Navy observed that beriberi was endemic among low ranking crew who often ate nothing but rice but not among crews of Western navies and officers who were entitled to a Western-style diet. Kanehiro initially believed that lack of protein was the chief cause of beriberi. With the support of Japanese navy, he experimented using crews of two battleships, one crew was fed only white rice, while the other was fed a diet of meat, fish, barley, rice, and beans. The group that ate only white rice documented 161 crew with beriberi and 25 deaths, while the latter group had only 14 cases of beriberi and no deaths. This convinced Kanehiro and the Japanese Navy that diet was the cause of beriberi. This was confirmed in 1897, when Christiaan Eijkman discovered that feeding unpolished rice instead of the polished variety to chickens helped to prevent beriberi in the chickens. The following year, Frederick Hopkins postulated that some foods contained "accessory factors"—in addition to proteins, carbohydrates, fats, etcetera—that were necessary for the functions of the human body.

Christiaan Eijkman, a Dutch physician and pathologist, demonstrated that beriberi is caused by poor diet. His work led to the discovery of vitamins. Together with Sir Frederick Hopkins, he was awarded the 1929 Nobel Prize for Physiology or Medicine for the discovery.

References

Footnotes

General references

Angstadt JD, Bodziner RA (2005). "Peripheral polyneuropathy from thiamine deficiency following laparoscopic Roux-en-Y gastric bypass". Obes Surg 15 (6): 890–2.
Hawk A (2006). "The great disease enemy, Kak'ke (beriberi) and the Imperial Japanese Army". Mil Med 171 (4): 333–9.
Diagnosing Beriberi in Emergency Situations, by Prof Mike Golden, Aberdeen University. (n.d.)
McIntyre N, Stanley NN (1971). "Cardiac beriberi: two modes of presentation". Br Med J 3 (5774): 567–9.

Mouly S, Khuong MA, Cabie A, Saimot AG, Coulad JP (1996). "Beri-Beri and thiamine deficiency in HIV infection". AIDS 10 (8): 931–2.

Shivalkar B, Engelmann I, Carp L, De Raedt H, Daelemans R (1998). "Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum". Acta Cardiol 53 (4): 195–9.
Jeb Sprague and Eunida Alexandra. Haiti: Mysterious Prison Ailment Traced to U.S. Rice - Inter Press Service (IPS). 17 January 2007.

Weise Prinzo Z, de Benoist B (2002). "Meeting the challenges of micronutrient deficiencies in emergency-affected populations". Proc Nutr Soc 61 (2): 251–7.