beriberi

enUK

beriberi

(bĕr`ēbĕr`ē), deficiency disease occurring when the human body has insufficient amounts of thiamine (vitaminvitamin,
group of organic substances that are required in the diet of humans and animals for normal growth, maintenance of life, and normal reproduction. Vitamins act as catalysts; very often either the vitamins themselves are coenzymes, or they form integral parts of coenzymes.
..... Click the link for more information. 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.

Beriberi

(B₁ avitaminosis, alimentary polyneuritis), an illness occurring as a result of a Vitamin B₁ (thiamine) deficiency in the diet. Characterized by polyneuritis of the extremities, disturbances of the cardiovascular system, and edema resulting from the accumulation of lactic and pyruvic acids in the body. Beriberi is found mostly in the countries of East, Southeast, and South Asia, where the population eats mainly rice which is hulled (that is, stripped of its outer coating). The cause of beriberi was established in 1897 by the Dutch physician C. Eijkman, working on the island of Java. Eijkman caused beriberi in hens by feeding them cooked, hulled rice and then cured them with rice siftings. The substance in rice siftings which protects against beriberi was found to be Vitamin B₁. The daily requirement of Vitamin B₁ is 1.6–2.5 mg for adult males, 1.3–2.2 mg for women, and 0.5–1.7 mg for children.

When Vitamin B¡ is absent from the diet, the carbohydrate metabolism of the body is disrupted, and lactic and pyruvic acids accumulate. Nervous disturbances (polyneuritis) in cases of beriberi may end in paralysis. The gait of a person afflicted by beriberi is characteristic; at the onset of the illness, he walks on his toes and the outer edge of the foot, sparing his soles. Then, as a result of weakness in the extremities, he transfers to crutches. The heart becomes enlarged and the pulse accelerates. The appetite decreases and constipation occurs. Severe general emaciation and generalized or localized edema are observed. Treatment consists in administering Vitamin B₁preparations internally and as injections. Prophylaxis consists in the introduction into the diet of foods containing a sufficient quantity of Vitamin B₁. Foods that do not contain Vitamin B₁ (bread and products of white flour of the highest and first grades; and sugar) should not, because of their high caloric value, constitute more than one-third of the caloric value of the diet. Massive prophylaxis consists in the inclusion in the diet of rye and wheat bread made of second-grade flour and of unhulled flour of several grains (buckwheat, oats, and barley) and the addition of Vitamin B₁ to wheat flour.

REFERENCES

Efremov, V. V. Vazhneishie avitaminozy cheloveka. Moscow-Leningrad, 1939.
“Avitaminozy.” In Rukovodstvo po vnutrennim bolezniam, vol. 8. Moscow, 1965. Pages 521–42.
Shimazono, N., and E. Katsura, eds. Review of Japanese Literature on Beriberi and Thiamine. Tokyo, 1965.

V. V. EFREMOV

beriberi

[¦ber·ē′ber·ē] (medicine) A disorder resulting from the deficiency of vitamin B₁ and characterized by neurologic symptoms, cardiovascular abnormalities, edema, and cerebral manifestations.

beriberi

enUK

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]

beriberi

ber·i·ber·i

beriberi

ber•i•ber•i

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beriberi

beriberi

Beriberi

REFERENCES

beriberi

beriberi

Beriberi

Definition

Description

Causes and symptoms

Diagnosis

Key terms

Treatment

Alternative treatment

Prognosis

Prevention

Dietary requirements

Food sources

Resources

Periodicals

beriberi

ber·i·ber·i

beriberi

ber·i·ber·i

ber·i·ber·i

beriberi

Words related to beriberi

noun avitaminosis caused by lack of thiamine (vitamin B1)

Related Words