Beriberi: a disease due to vitamin B1 deficiency

Beriberi is a condition that occurs due to a lack of nutrition containing vitamin B1. This condition is most common in countries where the diet consists mainly of polished rice. Peeled rice hardly contains this vitamin, which increases the risk of malnutrition. In Western countries it can also occur in chronic alcoholics. The disease can manifest itself in neurological problems or heart disease. The disease used to be more common. What exactly does beriberi mean?

History

Beriberi is caused by a deficiency of vitamin B1, also called thiamine . The foundation for research into this disease was laid at the end of the 19th century by the Dutch physician Christiaan Eijkman. He discovered that birds fed husked rice showed signs of beriberi and that they could recover if they were also fed the rice hulls. The name beriberi comes from Sinhala, the main language in Sri Lanka, and means: severe weakness. In 1912, the Polish biochemist Casimir Funk isolated the anti-beriberi factor from rice and a few years later the chemical formula of vitamin B1 was named.

How to get beriberi

This disease mainly occurs where the diet consists largely of ground rice. The rice hulls that are missing contain vitamin B1. This causes a deficiency of this vitamin. In Asia, where a lot of rice is eaten, this disease was very common, especially until the 19th century. In the Western world, this disease mainly occurs in chronic alcoholics who, due to their alcohol consumption in combination with malnutrition, suffer from disturbed absorption and storage of this vitamin. Furthermore, beriberi can develop in people who have undergone gastric reduction surgery in which the digestive tract has been rerouted, in kidney dialysis patients or in patients who receive nutrition outside the gastrointestinal tract (parenteral nutrition). Raw fish and shellfish contain many enzymes that break down vitamin B1. That is why this disease used to be common among sailors.

Symptoms

There are two forms of this disease:

  • Wet beriberi (cardiovascular system)
  • Dry beriberi (neurological system)

Wet beriberi
This form of beriberi damages the cardiovascular (heart and blood vessels) system. Edema (fluid retention) occurs due to the weakening of the small blood vessels. The symptoms that match this are:

  • Edema (fluid retention)
  • Shortness of breath
  • Heart: accelerated or abnormal rhythm, enlarged heart
  • Low negative blood pressure
  • Little urine production

Dry beriberi
This form of beriberi causes neurological disorders that can lead to paralysis. Usually a symmetrical failure occurs. There is often an ascending pattern, with the legs being affected first, followed by the arms and then the area around the mouth. If the vagus nerve is affected, the voice may be lost. In addition, all kinds of problems can arise due to poor brain functioning, such as: disorientation, eye movement disorders, psychiatric disorders and ultimately even coma and death.

Acute and chronic form

Patients suffering from this disease may have a combination of either dry or wet beriberi. In addition to the two forms of beriberi mentioned, a distinction can be made between an acute and chronic form. The acute form is called “Shoshin-beriberi” . Shoshin is the Japanese word for a sudden collapse (heart weakness) or damaged heart. The patient may die within 48 hours of pulmonary edema and low-output heart failure. The chronic form has the following phases: peripheral vasodilation (heart failure due to a decrease in resistance in the blood vessels), increase in cardiac output and insufficient compensation for the pressure loss, reduced renal function and overfilling of the tissues, which can cause edema.

Diagnosis

The diagnosis of beriberi can be made by determining the vitamin B1 in the blood. This blood concentration reflects the tissue concentration of this vitamin. Almost all thiamine (= vitamin B1) is located in the red blood cells. If the blood concentration is less than 90 nmol/L, there is a deficiency. A delay on the EEG may possibly be an indication of dry beriberi.

Treatment and prognosis

To treat this disease, vitamin B1 is administered by injection or in the form of a tablet. In addition, it is important to know what causes the thiamin deficiency so that not only the symptoms but also the cause can be addressed. Patients with wet beriberi who have been treated can show improvement quite quickly, sometimes within a few hours. Full recovery usually follows within two weeks. Dry beriberi responds less quickly to treatment and recovery does not always occur completely.

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