Beriberi disease: deficiency of the B vitamin thiamine

Imagine you feel tired all the time, your legs are tingling uncomfortably and your heart is racing for no apparent reason. What may initially sound like stress could actually be a sign of a serious illness: Beriberi. This often overlooked condition is caused by a deficiency of vitamin B1 (thiamine) and can have far-reaching consequences for our bodies. You can read here what exactly the deficiency disease is, how it is treated and what options there are to prevent beriberi.

Vitamin deficiency: what is beriberi and where does the name come from?

Beriberi, also known as beri-beri, is a condition caused by a severe deficiency of vitamin B1 (thiamine) in the body [1]. The name beriberi comes from the Sinhala language and means “I can't, I can't” - an apt description for the debilitating weakness that sufferers often experience.

Thiamine plays a crucial role in the body

Thiamine, also known as vitamin B1, is an essential vitamin that our body cannot produce itself. It plays a central role in energy metabolism and is particularly important for the function of nerves, muscles and the cardiovascular system [2].

What exactly does thiamine do in the body?

Thiamine is a coenzyme that is essential for important enzymes in carbohydrate metabolism. It helps our body to obtain energy from food and supports the normal functioning of the nervous system. Without sufficient thiamine, our body cannot effectively convert carbohydrates into energy, which can lead to a variety of problems:

Thiamine supports enzymes that are important for the breakdown of glucose and energy production in the cells.
Thiamine is essential for the function of the nervous system. It supports the transmission of stimuli between nerve cells and contributes to the synthesis of neurotransmitters such as acetylcholine.
Vitamin B1 is important for the normal function of the heart muscle and can support the heart's pumping capacity.
Thiamin trägt zur Aufrechterhaltung eines normalen Muskeltonus bei und ist wichtig für die Muskelfunktion und -regeneration.
It supports cognitive functions and mental health, including mood regulation.
Thiamine supports the immune system.
It helps with the production of hydrochloric acid in the stomach and is therefore important for normal digestion [3].

The causes of beriberi: more than just poor nutrition

The main reason for beriberi is a lack of vitamin B1 in the diet. However, the causes of this deficiency can be manifold:

Unbalanced diet: A diet consisting mainly of polished rice or highly processed carbohydrates can lead to a thiamine deficiency.

Alcohol abuse: Chronic alcohol consumption can impair the absorption and utilization of thiamine in the body.

Diseases: Crohn's disease can interfere with the absorption of thiamine in the gastrointestinal tract.

Increased requirement: Pregnancy, breastfeeding or fever can increase the body's thiamine requirement.

The two main forms of beri-beri disease

Beriberi can manifest itself in different ways, with two main forms being distinguished:

Dry beriberi: when the nerves suffer

The dry form of beriberi primarily affects the nervous system and can have serious neurophysiological consequences. Those affected often experience an unpleasant tingling and numbness that begins in the hands and feet and can increase over time. These sensory disorders are often accompanied by muscle weakness and atrophy, which significantly limits the mobility of those affected and increases the risk of falls. In addition, difficulties in walking and general motor insecurity make everyday life more difficult for these patients.

Speech disorders also frequently occur, which can make speaking and communication difficult. These physical symptoms are often accompanied by cognitive impairments, such as poor concentration and memory problems, which place an additional burden on everyday social and professional life [4].

Wet beriberi: when the cardiovascular system is affected

On the other hand, there is the wet form of beriberi, which affects the cardiovascular system. Patients often suffer from shortness of breath, which occurs even with minimal physical exertion and can significantly impair their quality of life. A rapid heartbeat, known as tachycardia, is also typical and can lead to cardiac overload in the long term. In addition, there is often edema in the legs, which is due to fluid accumulation in the tissues and is often associated with heart failure. These symptoms require rapid medical intervention to prevent irreparable damage [4].

Beriberi in babies: Symptoms of infantile beriberi

Infantile beriberi is a particularly dangerous form of beriberi disease that can occur in infants whose mothers have a significant thiamine deficiency during pregnancy or breastfeeding. The symptoms of this disease can manifest abruptly and pose a significant threat to the child's life:

Childhood beriberi often begins with unspecific signs such as irritability and reduced appetite, which makes early detection difficult.
Vomiting and diarrhea can occur suddenly and quickly lead to advanced dehydration. Breathing problems, including accelerated or labored breathing, require immediate medical intervention.
Most alarming, however, is the potential occurrence of heart failure, which can have fatal consequences without urgent treatment.

Symptoms of beriberi in infants must be treated quickly to prevent secondary damage [5].

Wernicke-Korsakow syndrome: the neurological complication

A severe thiamine deficiency can lead to Wernicke-Korsakow syndrome, a serious neurological disorder. This disorder consists of two related conditions: Wernicke's encephalopathy and Korsakov's syndrome [6].

Wernicke's encephalopathy is the acute phase of the disease. It is characterized by a sudden onset of a triad of symptoms including confusion, eye movement disorders and ataxia, a neurological disorder characterized by impaired coordination of movement and balance. The acute phase is potentially reversible with timely treatment.

Korsakov's syndrome, on the other hand, is the chronic phase that can develop if Wernicke's encephalopathy is not treated or is inadequately treated. It is characterized by severe memory impairment, in particular anterograde amnesia (inability to form new memories), retrograde amnesia (loss of memories before the triggering event) and confabulations (unconscious invention of stories to fill memory gaps).

Wernicke-Korsakow syndrome often occurs in people with alcohol problems, but can also have other causes. Symptoms include:

Confusion and disorientation
Pronounced memory impairment, especially with regard to short-term memory
Problems with eye movement, such as nystagmus and ophthalmoplegia
Gait disorders and ataxia
Reduction in drive and flattening of affect

While Wernicke's encephalopathy is often reversible with rapid intervention, the damage in Korsakow's syndrome is often irreversible. Early detection and treatment with high-dose thiamine is crucial for the prognosis.

Diagnosis and treatment of beriberi: recognizing and remedying the deficiency

The diagnosis of beriberi can be challenging as the symptoms are often non-specific. Doctors rely on a combination of clinical symptoms, dietary history and laboratory tests to determine the level of thiamine in the blood.

The treatment of beriberi aims to correct the thiamine deficiency and alleviate the symptoms:

Thiamine supplementation: As a rule, high doses of thiamine are administered, often initially intravenously and later orally.

Dietary changes: A balanced, thiamine-rich diet is crucial for long-term prevention.

Treatment of the underlying disease: If alcohol abuse or other diseases are the cause, these must also be addressed.

Symptomatic therapy: Depending on the severity of the symptoms, further treatment may be necessary, e.g. physiotherapy for muscle weakness or cardiac medication for cardiac symptoms.

Prevention: Preventing the deficiency

The best strategy against beriberi is prevention. To ensure adequate thiamine levels, you can do the following:

Balanced diet: Incorporate thiamine-rich foods into your diet. These include wholegrain products, pulses, nuts, meat and fish.

Be careful with processed foods: Avoid a diet consisting mainly of white flour, white sugar and other highly processed carbohydrates.

Moderate alcohol consumption: Excessive alcohol consumption can interfere with thiamine absorption and lead to an increased risk of beriberi.

Supplementation for increased requirements: Supplementation can be useful in phases with increased requirements, such as pregnancy or chronic illnesses. Talk to your doctor about this.

Beriberi in global comparison

While beriberi has become rare in many industrialized countries, it remains a relevant health problem in some regions of the world. In Southeast Asia, where polished rice is a staple food, beriberi still occurs more frequently because it is difficult for people to meet the daily requirement of thiamine. The German Nutrition Society recommends a vitamin B1 intake of 1 mg per day for adult women. Men need an average of 1.2 mg of thiamine per day. A child needs slightly less thiamine at a young age, whereas adolescents need a little more than adults. Infants are adequately supplied with small amounts of thiamine: they need just 0.2-0.4 mg daily [7].

In western countries today, beriberi mainly occurs in certain risk groups:

People with alcohol addiction
People with chronic gastrointestinal diseases
People with an unbalanced diet or eating disorders

Preventing beriberi

In this day and age, when we have access to a wide variety of foods, beriberi seems like a relic of times gone by. But despite technological and medical advances, the disease can still affect anyone today, regardless of their lifestyle or where they live. Especially in societies where fast food or processed carbohydrates dominate everyday life and valuable nutrients are often neglected, the risk of thiamine deficiency can inadvertently increase.

In addition, global economic and environmental challenges, such as food shortages or unequal distribution of resources, make beriberi a threat that has never completely disappeared in certain regions. Chronic diseases that impair nutrient absorption and social factors such as poverty, husked rice as a staple food or alcohol abuse also contribute to the persistence of this actually preventable deficiency disease.

We should therefore all take preventive measures, be aware of the importance of a balanced diet and try to keep our thiamine intake high enough to prevent an undersupply and a general vitamin deficiency.

Sources:

[1] https://www.gesundheit.gv.at/lexikon/B/beri-beri.html
[2] https://www.klartext-nahrungsergaenzung.de/vitamin-b1-thiamin-fuer-herz-und-nerven
[3] https://www.dge.de/gesunde-ernaehrung/faq/thiamin/
[4] https://www.msdmanuals.com/de/vitamine/thiaminmangel
[5] https://gpnotebook.com/de/beriberi-im-kindesalter
[6] https://www.lecturio.de/wernicke-enzephalopathie-und-korsakow-syndrom/
[7] https://www.dge.de/referenzwerte/thiamin/