Beriberi: Understanding Thiamine (Vitamin B1) Deficiency

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Running low on thiamine (a type of B vitamin) could put you at risk for a serious condition called beriberi. Since so many foods are rich in thiamine, beriberi is very rare in the United States. However, alcohol abuse and certain medical issues can increase your risk for thiamine deficiency.

Also known as vitamin B1, thiamine plays a key role in converting carbohydrates into energy. It’s also involved in the process of muscle contraction, as well as the transmission of nerve signals and the production of acids essential for proper digestion. While it’s mostly concentrated in your skeletal muscles, thiamine is also found in your brain, heart, liver, and kidneys.

When left untreated, beriberi can severely deplete your energy levels and result in life-threatening problems with your heart or nervous system.

Types of Beriberi: Wet vs. Dry

There are two types of beriberi: wet beriberi (which affects the cardiovascular system) and dry beriberi (which affects the nervous system). If it goes unchecked, wet beriberi may cause injury to the heart’s muscle tissue. It’s also associated with congestive heart failure, in which the heart can’t pump enough blood to meet the body’s needs.

Dry beriberi injures the nerves and can lead to muscle strength loss and, eventually, paralysis. If the condition is detected and treated in its early stages, damage to the nervous system is usually reversible. Lack of early treatment may result in such complications as permanent memory loss.

Wernicke-Korsakoff syndrome is a type of brain disorder caused by a lack of thiamine. Typically, symptoms of Wernicke's disease are first to appear. Symptoms include confusion, loss of muscle coordination, and changes in vision such as nystagmus (rapid, uncontrolled eye movements). Korsakoff syndrome often develops later, with symptoms including memory loss, difficulty forming new memories, hallucinations, and making up stories (called confabulation).

Causes

Because drinking heavily interferes with your body’s ability to absorb and store thiamine, alcohol abuse is one of the main causes of beriberi today.

In very rare cases, beriberi occurs as a genetic disorder. For some individuals with this condition, the ability to absorb thiamine from foods gradually weakens with age.

Additionally, breastfed infants can develop beriberi when the mother’s body lacks sufficient thiamine.

Risk Factors

Along with alcohol abuse, issues like prolonged diarrhea and pregnancy-related vomiting are among the risk factors for beriberi.

In addition, undergoing dialysis, taking high doses of diuretics, and receiving bariatric surgery can all raise your risk of thiamine deficiency. People with hyperthyroidism, AIDS, or severe liver disease may also be more prone to this condition.

Symptoms

The most common symptoms of wet beriberi include:

  • Increased heart rate
  • Shortness of breath (including awakening at night short of breath)
  • Swelling of the lower legs

In cases where wet beriberi leads to congestive heart failure, individuals may experience the following symptoms:

  • Difficulty breathing accompanied by bulging neck veins 
  • Enlarged heart
  • Fluid in the lungs
  • Rapid heartbeat

For dry beriberi, symptoms typically include: 

  • Difficulty walking
  • Loss of feeling in the hands and feet
  • Loss of muscle function or paralysis of the lower legs
  • Mental confusion
  • Pain
  • Speech difficulties
  • Strange eye movements
  • Tingling
  • Vomiting

Prevention

Following a balanced diet is your best bet for prevention of beriberi. To get your fill of thiamine, load up on the following foods:

  • Beans and legumes
  • Dairy products (such as yogurt)
  • Eggs
  • Meat, poultry, and fish
  • Nuts and seeds
  • Thiamine-enriched breakfast cereals
  • Whole grains

The following vegetables are also high in thiamine:

  • Acorn squash
  • Asparagus 
  • Beet greens
  • Brussels sprouts
  • Spinach

It should be noted that a number of foods contain thiaminases, which are enzymes found to render thiamine inactive. These foods include:

  • Vlams
  • Milled rice
  • Mussels
  • Shrimp

Limiting your intake of such foods may also aid in the prevention of beriberi.

Treatment

Treatment of beriberi focuses on restoring the body’s thiamine levels. Some patients are treated with thiamine supplements, while others receive thiamine injections.

In most cases, undergoing treatment for beriberi alleviates symptoms and reverses damage to the heart or nervous system.

Failure to treat beriberi (and Wernicke-Korsakoff syndrome) can result in permanent damage to the heart and/or nerves, as well as coma, psychosis, and even death.

Vitamin B Supplementation

If you’re a heavy drinker, taking vitamin B supplements isn’t recommended as a prevention strategy for beriberi. According to the Substance Abuse and Mental Health Services Administration, heavy alcohol use is defined as binge drinking (i.e., consuming about four drinks for women and five drinks for men) on five or more days in the past month.

If you’re experiencing any signs of thiamine deficiency, consult your physician as soon as possible.

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