Beriberi Disease: Symptoms, Causes, and Treatment

Beriberi symptoms can be alarming and life-threatening, yet this condition is often preventable. Affecting millions worldwide, particularly in areas with poor nutrition, beriberi is caused by a thiamine (vitamin B1) deficiency. Understanding its symptoms, causes, and treatment is crucial for early intervention and recovery. Let’s delve deeper into what beriberi is and how it affects the body.

What is Beriberi?

Beriberi is a medical condition resulting from a severe deficiency of thiamine (vitamin B1), an essential nutrient for metabolism, nerve function, and heart health. It manifests in two primary forms:

• Wet Beriberi, which affects the cardiovascular system
• Dry Beriberi, which impacts the central nervous system

Both forms can lead to significant health issues, including heart failure, muscle paralysis, and neurological damage if left untreated. In the next section, we’ll explore the various symptoms associated with beriberi.

Types of Beriberi

Beriberi is classified into two primary forms, each impacting different body systems.

1. Wet Beriberi

Wet beriberi mainly affects the cardiovascular system, causing poor circulation, fluid accumulation in the tissues, and heart abnormalities. Symptoms include increased heart rate, breathlessness, swelling in the legs and feet, and in severe cases, heart failure and oedema. In contrast, dry beriberi primarily impacts the nervous system.

2. Dry Beriberi

Dry beriberi chiefly affects the nervous system, leading to nerve degeneration, muscle weakness, and pain. Symptoms include a tingling sensation in the toes, burning feet, leg cramps, reduced muscle function, numbness or loss of sensation in the hands and feet, and potential paralysis. The primary cause of both types of beriberi is a severe deficiency in thiamine (vitamin B1).

Beriberi Causes

Beriberi is primarily caused by a severe deficiency in thiamine (vitamin B1), which can occur due to:

• Dietary deficiency: Consuming a diet low in thiamine, especially one consisting mainly of white rice or highly processed carbohydrates
• Alcohol use disorder: Alcoholism can impair thiamine absorption and increase its excretion
• Food insecurity: Common in regions with limited access to nutritious food
• Medical conditions: Conditions such as hyperemesis gravidarum, AIDS, and complications from bariatric surgery can also lead to thiamine deficiency

Beriberi Symptoms

The symptoms of beriberi vary depending on the type of the disease. Below are the key symptoms:

• General symptoms: Fatigue, irritability, poor memory, loss of appetite, sleep disturbances, and abdominal discomfort
• Wet beriberi symptoms: Increased heart rate, shortness of breath, swelling in the legs and feet, rapid heart rate, and fluid accumulation in the lungs
• Dry beriberi symptoms: Numbness in hands and feet, muscle weakness, paralysis in lower legs, general pain, body aches, vomiting, and mental confusion
• Wernicke-Korsakoff syndrome: Confusion, memory loss, rapid eye movement, involuntary eye movements, blurred or double vision, and hallucinations in severe cases

Symptoms of Dry Beriberi

Dry beriberi primarily affects the nervous system, causing a range of neurological and muscular symptoms, such as:

• Gradual muscle weakness and wasting, particularly in the legs
• Numbness, tingling, and loss of sensation in the hands and feet
• Difficulty walking due to impaired motor function and balance
• Reduced or absent tendon reflexes
• Mental confusion, memory problems, and speech difficulties
• Involuntary eye movements (nystagmus) and pain in the extremities

These symptoms develop gradually and can worsen over time if left untreated. In addition to the neurological symptoms, individuals with dry beriberi may also experience some of the cardiovascular symptoms associated with wet beriberi.

Symptoms of Wet Beriberi

Wet beriberi primarily affects the cardiovascular system, leading to severe heart and circulatory symptoms, including:

• Rapid heart rate (tachycardia) and high-output heart failure
• Shortness of breath (dyspnea) and swelling (edema) in the lower legs or throughout the body
• Widening of blood vessels (vasodilation) and decreased systemic vascular resistance
• Elevated pressure in the jugular veins (jugular venous distension)
• Chest pain and overall fatigue due to the strain on the heart

These symptoms can develop rapidly and may be life-threatening if not promptly treated. Individuals with wet beriberi are at risk of developing serious complications if the underlying thiamine deficiency is not addressed. Several factors can increase the risk of developing beriberi.

Risk Factors of Beriberi

Beriberi is associated with several risk factors that increase the likelihood of thiamine deficiency, such as:

• Poor diet lacking in thiamine-rich foods or high in refined carbohydrates
• Chronic alcohol consumption, which impairs thiamine absorption and utilisation
• Gastrointestinal disorders that affect nutrient absorption, such as Crohn’s disease or celiac disease
• Bariatric surgery, which can lead to post-surgical nutritional deficiencies
• Pregnancy and hyperthyroidism, which increase nutritional demands and may impair absorption
• High stress levels and chronic illnesses, such as HIV/AIDS or cancer, which can deplete thiamine stores

Complications of Beriberi

If left untreated, beriberi can lead to severe and potentially life-threatening complications, including:

• High-output cardiac failure, particularly in cases of wet beriberi
• Permanent nerve damage and neurological impairments in dry beriberi
• Lactic acidosis, an accumulation of lactic acid in the blood due to impaired cellular metabolism
• Respiratory distress and failure, especially in advanced stages of the disease
• Death, particularly in infantile beriberi and severe cases of wet beriberi

Beriberi Diagnosis

Diagnosing beriberi involves a combination of clinical assessment and specific diagnostic tests, such as:

• Thorough clinical examination to identify the presence of risk factors, ocular abnormalities, ataxia, and confusion
• Erythrocyte thiamine pyrophosphate test to measure thiamine levels in red blood cells
• Arterial blood gas and lactate tests to assess the patient’s metabolic status
• MRI brain imaging to rule out other neurological conditions that may mimic beriberi symptoms
• Thyroid function tests to check for hyperthyroidism, which can affect thiamine absorption and utilisation

Beriberi Treatment

Treatment for beriberi focuses on replenishing thiamine (vitamin B1) levels in the body to alleviate symptoms and restore normal functions. This is typically done through:

• Thiamine supplements, either taken orally or administered intravenously, are the primary treatment for beriberi, especially in severe cases.
• Dietary changes, such as incorporating thiamine-rich foods like whole grains, legumes, nuts, and lean meats, are essential for long-term management.
• Doctors will monitor progress through follow-up blood tests to ensure the body is absorbing the vitamin adequately.
• With proper treatment, symptoms often resolve within a few weeks to months.

Prevention of Beriberi

Preventing beriberi involves maintaining a balanced diet rich in thiamine and avoiding risk factors that can lead to a deficiency.

• Eating a nutrient-dense diet that includes thiamine-rich foods such as beans, legumes, seeds, meat, fish, whole grains, and fortified cereals is crucial.
• Limiting alcohol consumption is essential, as excessive alcohol intake can interfere with thiamine absorption.
• Ensuring that infant formula and other foods are enriched with thiamine can help prevent deficiencies in young children.
• Maintaining a healthy lifestyle by avoiding extreme diets, excessive physical activity, and managing stress levels can also reduce the risk of beriberi.

When to Seek Medical Help

Individuals should seek medical help immediately if they suspect a thiamine deficiency or experience symptoms of beriberi.

• Early symptoms include muscle weakness, fatigue, shortness of breath, swollen legs, and tingling or numbness in the hands and feet.
• Severe symptoms, such as rapid heart rate, mental confusion, difficulty speaking, vomiting, or involuntary eye movements, require urgent medical attention.
• High-risk groups, including individuals with alcohol use disorder, pregnant women with hyperemesis gravidarum, people post-bariatric surgery, and those with AIDS, should be particularly vigilant.

Conclusion

Beriberi, a condition caused by thiamine deficiency, can be effectively managed with prompt medical intervention and dietary adjustments. Early diagnosis and treatment are crucial to prevent irreversible nerve and heart damage. A balanced diet rich in thiamine and regular health check-ups can significantly reduce the risk of developing beriberi. By understanding the symptoms, causes, and treatment options, individuals can take proactive steps towards maintaining good health and preventing this condition.

Frequently Asked Questions (FAQs)

References

• https://www.ncbi.nlm.nih.gov/books/NBK537204/
• https://academic.oup.com/nutritionreviews/article/78/12/1015/5835520
• https://pmc.ncbi.nlm.nih.gov/articles/PMC10723625/
• https://www.journalmc.org/index.php/JMC/article/view/1780/1129
• https://journals.lww.com/md-journal/fulltext/2018/03020/wet_beriberi_with_multiple_organ_failure.4.aspx