bERIBERI
TABLE OF CONTENTS
01 HISTORY
05 SYMPTOMS
Discovery and background of Beriberi
Symptoms experienced while being
affected by Beriberi
02 CAUSES
06 TREATMENT
Risk factors and other causes of
Beriberi
Standard practices and cost of
treatment for Beriberi
03 EPIDEMIOLOGY
07 pREVENTION
Affliction, prognosis and populations
affected by Beriberi
Preventive strategies for Beriberi
04 DIAGNOSIS
08 RESOURCES
Diagnosis criteria and available
testing.
INTRODUCTION
Thiamine deficiency is a medical condition of low levels of
thiamine (vitamin B1). The severe and chronic form of thiamine
deficiency is known as Beriberi.
Thiamine is a vitamin used to turn food into energy and keep the
nervous system healthy.
VOCABULARY WORDS TO KNOW
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Healthful Diet: A diet that provides the proper combination of energy and nutrients and is adequate, moderate,
nutrient-dense, balance, and varied.
Vitamin: Organic compounds that assist in the regulation of many body processes and the maintenance of many body
tissues
Water-soluble vitamin: Vitamins that are soluble in water. The vitamins are carried through the bloodstream and
excess are eliminated in urine.
Dietary Reference Intakes (DRIs)- A set of nutritional reference values for the United States and Canada that applies
to healthy people.
Recommended Dietary Allowance (RDA) - The average daily intake level estimated to meet the needs of nearly all
people in a certain group.
Adequate Intake (AI) The average daily intake level assumed to be adequate. Used when no RDA is available.
Processed Foods: Foods that have been manipulated in some way to transform raw ingredients into products for
consumption.
Enriched Foods: Foods in which nutrients that were lost during processing have been added back, so that the food
meets specified standard.
Fortified Foods: Foods in which nutrients are added that did not originally exist in the food, or which existed in
insignificant amounts.
Edema: A disorder in which fluids build up in the tissue spaces of the body, causing fluid imbalances and a swollen
appearance.
Alcohol Abuse: A pattern of alcohol consumption, weather chronic or occasional, that results in harm to one’s health,
function, or interpersonal relationships.
Neurotransmitters: Chemical compounds that transmit messages from one nerve cell to another.
Cofactor: A mineral or non-protein compound that is needed
01
hISTORY
Discovery and background of
Beriberi
hISTORY
01
ORIGIN OF NAME
02
dATE OF dISCOVERY
The term beriberi is said to be derived from
the Sinhalese¹ word beri meaning
“weakness”.
Beriberi in some form has been documented
since the 3rd century. The first document
was made in an Ancient Chinese medicine
book by Chinese Scholar Ge Hong.
¹Sihalese is the official language of Sri Lanka,
having been adapted from a native language of
Northern India.
03
DISCOVERER
04
HISTORY OF DISEASE
The credit for Beriberi discovery has been
given to Polish chemist Casimir Funk in
1911.
While Beriberi has been noted in some form
since the 3rd century, it did not become a
widespread problem until the 19th century.
During that time, processing of grains
became easier and consumers expected it.
These outer layer of the grain, the bran, was
removed during this processing. The bran
was discovered to contain the highest
concentrations of B-Vitamins in the grain.
HISTORY OF DISCOVERY
GE HONG - CHINESE
Scholar Ge Hong first wrote of an
illness which he referred to as jiao qui
(foot qi/air) during the 3rd Century.The
symptoms include swelling ,weakness,
and numbness of the feet. He found
that eating certain foods, such as
fermented soybeans, cured the
symptoms.
CASIMIR FUNK - POLISH
CHRISTIAAN EIJKMAN - DUTCH
Physician Christiaan Eijkman was
given the task of finding the causes
of Beriberi as it had caused many
Dutch colonists in Asia to fall ill. By
chance, he noted that hens that were
fed milled rice were afflicted by
similar symptoms. Further research
in 1897 led to the conclusion that
there was a substance in the husk of
rice that counteracted the illness.
Chemist Casimir Funk was able to
isolate the water-soluble nitrogencontaining compound in rice bran that
was believed to be the substance that
cured Beriberi. He referred to the
compound as “vital amine” later
calling the specific compound
“thiamin.” Thiamine was was later
designated as Vitamin B1 as it was
the first B vitamin discovered.
02
CAUSES
Risk factors and other causes
of Beriberi
CAUSES
01
cAUSE OF BERIBERI
02
RISK FACTORS
Beriberi is a disease that is caused by a
vitamin B1 deficiency. Beriberi is also known
as Thiamine Deficiency.
Risk factors for Beriberi include a diet of
primarily white milled rice, alcoholism, being
on dialysis, having chronic diarrhea, and
chronic diuretic use.
Persons may become deficient in thiamine
by not ingesting enough vitamin B1 through
the diet or may become deficient through
excess bodily use. Hyperthyroidism,
pregnancy, lactation, or fever can increase
the bodies vitamin B1 intake.
Polished
“White”
Rice
A rare non-hereditary condition called
genetic Beriberi can block the body’s ability
to absorb vitamin B1 from foods.
Persons who may have a higher risk of
Beriberi include older adults, people with
diabetes , people with HIV and people who
have had bariatric surgery
Unpolished
“Brown”
Rice
03
EPIDEMIOLOGY
Affliction, prognosis and
populations affected by
Beriberi
01
POPULATIONS MOST AFFECTED
02
AFFLICTION ONSET
Beriberi is not specific to race, gender, or
age.
Beriberi can occur in as little as 4 weeks.
When thiamine stores are depleted
symptoms start to appear. Once afflicted
with Beriberi it is not contagious.
EPIDEMIOLOGY
In the United State Beriberi is commonly
found among chronic alcohol abusers,
people with eating disorders and people on
fad diets.
Internationally, Beriberi occurs in refugee
camps and other settlements dependent on
poor-quality emergency food aid. Developing
countries also are known to have more
vitamin deficiency problems in general,
Beriberi being reported among them.
03
PROGNOSIS
Beriberi can be quickly fatal. However, it is
one of the most easily treatable vitamin
deficiency conditions, with remarkable
recovery being possible even in severe
cases. Thus, the patient prognosis for
beriberi is usually good.
Table 1:
Map depicting countries where the estimated per capita availability of
thiamine in the national food supply (as per food balance sheets) is below
the recommended nutrient intake for men of 1.2 mg/day (in turquoise), and
countries where rice or wheat flour fortification is in place to address low
thiamine availability (in yellow). Countries where the estimated mean
thiamine availability is greater than or equal to 1.2 mg/day are in gray.
Karen people in a refugee camp in Thailand eating their
everyday meal. Food in picture contains dried stinky fish
paste, rice and marinated vegetable..
John, brother of a friend of
mine lacked thiamine
04
dIAGNOSIS
Diagnosis criteria and available
testing.
01
AVAILABLE TESTING
dIAGNOSIS
Due to most cases of Beriberi being from
developing countries, most diagnosis are
made during a physical examination and the
subsequent observation for a clinical
response after being administered thiamine.
If Beriberi is suspected in developed
countries, doctors can request urine samples
to measure urinary thiamine excretion, a
whole blood test to measure thiamine levels,
or a thiamine loading test (while the most
accurate this is a very expensive test).
Doctors also recommend a physical exam
take place to check for neurological damage
as well as issue with the heart.
02
DIAGNOSIS CRITERIA
If a patient responds to treatment of
thiamine administration, it is safe to assume
that a measure of thiamine deficiency was
responsible for the condition.
For laboratory testing, a thiamine blood level
below the reference range of 2.5-7.5 μg/dL, is
considered deficient. For a urinary test an any
thiamine levels following below the reference
range of 100-200 µg/24 hours is considered
deficient.
During thiamine loading testing, a diagnosis
must have at least a 15% increase of enzyme
activity to be a definitive marker of Beriberi.
Physical examination can show swelling,
fatigue, irritation, poor memory, and
constipation. Neurological examinations can
show changes in walking, coordination
problems, decreased reflexes and drooping
eyelids.
05
SYMPTOMS
Symptoms experienced while
being affected by Beriberi
SYMPTOMS
01
GENERAL SYMPTOMS
Thiamin helps the body's cells change
carbohydrates into energy. Due to the lack of
thiamine in the body general symptoms of
Beriberi include a combination of fatigue,
apathy, muscle weakness, and reduced
cognitive function.
02
BODY SYSTEMS AFFECTED
Wet Beriberi affects the circulatory system.
Dry Beriberi affects the nervous and muscular
system. Rare forms of Beriberi includes
infantile Beriberi which affects the infants
circulatory system and gastrointestinal which
affects the digestive system.
A patient showing
symptoms of Wet
Beriberi
A patient showing
symptoms of Dry
Beriberi
DRY BERIBERI
DRY BERIBERI
Dry Beriberi primarily affects the nervous system
leading to the degeneration of the nerves.
Symptoms Include :
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Difficulty In Walking
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Tingling Or Loss Of Sensation (Numbness)
In Hand And Feet
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Loss Of Tendon Reflexes
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Loss Of Muscle Function Or Paralysis Of The
Lower Legs
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Mental Confusion/Speech Difficulties
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Pain
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Involuntary Eye Movements
Thiamine is important to the health of the nervous
system because of its role in the synthesis of
acetylcholine, an important neurotransmitter.
Patient has lost muscle function
in lower legs due to Dry Beriberi
WET BERIBERI
SYMPTOMS
Wet Beriberi mainly affects the
cardiovascular system, causing poor
circulation and fluid buildup in the
tissues.
Symptoms include:
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Increased Heart Rate
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Shortness Of Breath During
Physical Activity
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Waking Up Short Of Breath
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Swollen Lower Legs
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Edema
Heart failure due to Wet Beriberi is
thought to be a consequence of
impaired oxidative metabolism.
Severe thiamine deficiency interrupts
the chemical process in which
oxygen is used to make energy from
carbohydrates due to not being able
to help produce cofactor Thiamine
Pyrophosphate (TPP).
^ Above: Heart failure in Wet
Beriberi
< Left: Edema in Wet Beriberi
SYMPTOMS
GASTROINTESTINAL
BERIBERI
Gastrointestinal Beriberi is usually
experienced by those in the beginning stages
of Wernicke’s Encephalopathy (form of Dry
Beriberi). Symptoms include:
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Abdominal pain
Nausea
Vomiting
Lactic acidosis
INFANTILE
BERIBERI
Infantile Beriberi usually occurs between two and six
months of age in children whose mothers have inadequate
thiamine intake. It may present as either wet or dry
Beriberi. Unique symptoms include:
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Hoarseness, where the child makes moves to
moan but emits no sound or just faint moans,
caused by nerve paralysis
Weight loss
Vomiting
Diarrhea
Pale skin
Edema
Ill temper
06
TREATMENT
Treatment for Beriberi
TREATMENT
01
COMMON TREATMENT
02 TREATMENT FOR ALCOHOL RELATED
bERIBERI
The most common treatment for wet and dry
Beriberi are oral thiamine supplements.
Doctors may also prescribe eating more B1
rich foods such as whole-grain cereals, beans
and beef. Recovery can be seen as quickly as
12 hours and hospitalization is not required.
This is an effective and affordable treatment.
Treatment for Alcohol-related Beriberi
patients require a higher dose of thiamine
than non-alcohol-related Beriberi patients,
thus making treatment marginally expensive.
The causes of the higher dose is because
alcohol can inhibit the uptake of vitamin B1
and the phosphorylation of its active form
(TPP)
03
EXTREME TREATMENT
04
RISK OF TREATMENT
In extreme cases of Beriberi daily
intravenous treatment of 100 to 200mg of
thiamine is required. Most treatment lasts
up to seven days and may require
hospitalization. Additional doses of
intravenous thiamine should be increased
based on the presence of life-threatening
condition. Continued administration of oral
thiamine is often recommended after
intravenous therapy to prevent further
complications.
There is no current reported risk of treatment
for Beriberi. Due Vitamin B1 being watersoluble, there are no known adverse effects
of consuming excess amounts of thiamine.
07
PREVENTION
How to prevent Beriberi
01
EAT VITAMIN ENRICHED FOODS
PREVENTION
The US requires the enrichment of white rice
with thiamine when distributed by
government programs to schools, non profits,
and foreing countries to prevent thiamine
deficiency.
02
EAT VITAMIN FORTIFIED FOODS
Many breakfast cereals and other grain based
meals are now fortified with thiamine.
Currently fortified foods provide 50% of total
thiamine intake in industrial countries.
03
LIMIT ALCOHOL CONSUMPTION
04
AVOID THIAMINASES IN DIET
Chronic alcohol consumption can inhibit the
uptake of thiamine leading to the vitamin
being washed out of your body and not
absorbed.
Thiaminase are enzymes found in a few
plants and the raw flesh and viscera of
some carp. When ingested, these enzymes
split thiamin and render it inactive. Exposing
the plant to heat treatment and cooking the
fish will inactivate the Thiaminase making it
safe for consumption.
05
EAT FOODS RICH IN THIAMINE
05
Foods RICH IN THIAMINE
PREVENTION
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TABLE 2
Whole-grain bread & pasta
Grains & Cereals
Pork
Vegetables (ie,
okra,asparagus,
tomatoes)
Legumes ( beans, nuts,
seeds)
Source: USDA Food Data Central https://fdc.nal.usda.gov/
PREVENTION
TABLE 3
NUTRITIONAL NEEDS FOR SPECIFIC AGE GROUPS
POPULATION
AGE
ALLOWANGE, mg/day
DIETARY REFERENCE INTAKE
INFANTS
0-6 months
0.2mg/day
Adequate Intake
INFANTS
7-12 months
0.3 mg/day
Adequate Intake
CHILDREN
1-3 years
0.5 mg/day
Recommended Dietary Allowances
CHILDREN
4-8 years
0.6 mg/day
Recommended Dietary Allowances
BOYS
9-13 years
0.9 mg/day
Recommended Dietary Allowances
MEN
>14 years
1.2 mg/day
Recommended Dietary Allowances
GIRLS
9-18
1.0 mg/day
Recommended Dietary Allowances
WOMEN
>19
1.1 mg/day
Recommended Dietary Allowances
PREGNANT/LACTATING
WOMEN
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1.4 mg/day
Recommended Dietary Allowances
08
RESOURCES
Adamolekun, B., Bergeron, G., Bettendorff, L., Bourassa, M., Brown, K., Combs Jr, G., Cox, L., Fattal-valevski,
A.,...Wieringa,
F. (Updated: 2018, August 08). Thiamine deficiency disorders: diagnosis, prevalence,
and a roadmap for global
control programs. Retrieved from New York Academy of Sciences Wiley Online Library:
RESOURCES
https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/nyas.13919
Dalawari, P. (Updated: 2014, February 05). Vitamin B1 (Thiamine): Reference Range, Interpretation, Collection and
Panels. Retrieved from Medscape Website :
https://emedicine.medscape.com/article/2088582
Manore, M., Thomson, J. (2017). Nutrition: An Applied Approach. New York, NY: Pearson
Nguyen-khoa, D. (Updated: 2020 March 31). Beriberi (Thiamine Deficiency). Retrieved from Medscape Website:
https://emedicine.medscape.com/article/116930