Manifestation of thiamine deficiency

Beriberi is caused by thiamine (vitamin B1) deficiency and also known as thiamine deficiency. It is most serious in infants due to their rapid growth and development that occurs during this time and the relatively high thiamine needs compared to body size.

Beriberi is rare in the United States. The disease often occurs in developing countries among people with a diet that consists mostly of white rice or highly refined carbohydrates. Thiamine deficiency can develop within 2-3 months of a deficient intake and can cause disability and death.

Thiamine is required for the production of ribose, RNA, DNA, nicotinamide adenine dinucleotide (NAD), and adenosine triphosphate (ATP). It is particularly important in tissues that are highly metabolically active, including neurons, cardiac myocytes, and erythrocytes, all of which rely on glucose as a main energy substrate.

Thiamine deficiency leads to impaired glucose metabolism, decreased delivery of oxygen by red blood cells, cardiac dysfunction, failure of neurotransmission, and neuronal death.

Early symptoms of thiamin deficiency are nonspecific: fatigue, irritability, poor memory, sleep disturbances, precordial pain, anorexia, and abdominal discomfort.

There are 2 major manifestations of thiamine deficiency: cardiovascular disease (wet beriberi) and nervous system disease (dry beriberi and Wernicke–Korsakoff syndrome).

Wet beriberi: mainly affects the cardiovascular system, causing poor circulation and fluid buildup in the tissues. Usually presents as predominantly right sided heart failure associated with a high cardiac output or less frequently as cardiovascular collapse.

Dry beriberi: primarily affects and damages the nerves and can lead to decreased muscle strength, eventually muscle paralysis.

In extreme cases, beriberi is associated with Wernicke-Korsakoff syndrome. Wernicke encephalopathy and Korsakoff syndrome are two forms of brain damage caused by thiamine deficiency.

The disorder (or spectrum of disorders) is classically associated with a diet consisting largely of polished rice (oriental beriberi), but may also arise if highly refined wheat flour forms a major part of the diet, and in food faddists (occidental beriberi). Nowadays, beriberi occurs mostly in people who abuse alcohol. Drinking heavily can lead to poor nutrition. Excess alcohol makes it harder for the body to absorb and store vitamin B1.
Manifestation of thiamine deficiency

Christiaan Eijkman and beriberi

During the time period of the Dutch beriberi problem in Indonesia, physicians were preoccupied with the concept that diseases were cause by pathological problem.

In 1886 Christiaan Eijkman and other physicians began the quest for identifying the beriberi microbe and developing procedures for eliminating the disease. As a former student of Robert Koch, he had been trying to isolate and infect chickens with ‘beriberi bacteria’.

Early discovery, which demonstrated the specificity of the dietary essentials, was Eijkman’s production of beriberi on chickens in 1897 by feeding them polished rice.

The polished cooked rice had resulted in beriberi symptoms of peripheral neuritis. This disease was prevented or cured by feeding either a diet of unpolished rice or a diet to which alcoholic extract of rice bran was added. Eijkman thought that a toxin in rice was being unmasked in the conversion of brown to white rice.

In 1901, Gerrit Grijns, Eijkman’s successor, observed that chicken fed on raw meat did not develop polyneuritis whereas those exclusively fed on meat that has been heated long enough at 120° C developed the disease.

After further work, his statement in 19o1 was perhaps the progenitor of the “vitamin era” in nutritional research: “There occur in various natural foods substances which cannot be absent without serious injury… they are easily disintegrated … and cannot be replaced by simple chemical compounds.”
Christiaan Eijkman and beriberi

Thiamine deficiency and their symptoms

Thiamine efficiency can cause cardiovascular and neurological signs and symptoms. Beriberi a serious thiamine efficiency disease, usually affects Asians, who subsist mainly on a diet of unenriched rice and wheat.

Among the symptoms of beriberi: chiefly nervous and cardiovascular systems affected; mental confusion, muscular weakness, loss of ankle and knee jerks, painful calf muscles, peripheral paralysis, edema (wet beriberi), muscle wasting (dry beriberi), enlarged heart.

In the United States, although uncommon, it usually occur in alcoholics, malnourished young adults, and infants who are on a low proteins diet or are being breast-fed by thiamine efficient mothers.

Sign and symptoms of infantile beriberi include cyanosis, dyspnea, tachycardia, aphonia (soundless crying), and eventual cardiac failure.

Although whole grains may be rich in thiamine, processing of grains significantly reduces their thiamine content. Likewise, because thiamin is water soluble and heat sensitive, cooking largely results in the loss or destruction of this vitamin especially when chlorinate waster is used.
Thiamine deficiency and their symptoms

Discovery of Thiamine

Thiamine was the first vitamin to be discovered. Kanehiro Takaki, a Japanese naval doctor, was the first to report that beriberi seemed to be a nutritional deficiency based on reducing the incidence of beriberi in Japanese sailors by giving them additional meat, dry milk and vegetables.

Christiaan Eijkman, a Dutch military surgeon, who traveled to the Dutch East Indies to study beriberi, in 1890s began to clarify the role of diet in the development of beriberi.

Eijkman discovered that a disease similar to beriberi occurred in birds that were fed a diet of steam-cooked polished rice, as opposed to crude rice.

In 1926, thiamine was the first B vitamin isolated, as a crystalline, water soluble, yellowish white powder with a salty, slightly nutty taste. It was crystallized from rice polishing by two Dutch scientists Barend Jansen and W. F. Donald as antineuritic vitamin.

By 1936 it had been synthesized and its chemical structure determined by Robert R. Williams which he named ‘thiamine’.

The discovery of thiamine revolutionized the management of wet beriberi because thiamine quickly reversed the cardiac manifestations of the disease.
Discovery of Thiamine

Beriberi Disease

Beriberi is a deficiency disease which is caused by the absence of vitamin B1 in our diet. It is a serious disease.

The disease was accurately described for the first time in 1629 by the Leiden physician Jacobs de Bondt.

He noted that the word ‘beriberi’ was derived from a local word for sheep because of the tottering walk of those affected disease.

Beriberi is characterized by degenerative changes in the nervous system which cause pain, weakness and paralysis of the limbs, by edema and by hypertrophy of the heart which causes shortness of breath and other cardiac symptoms and frequently ends in heart failure and death.

Vitamin B1 or thiamine also known as anti-beriberi or antineuritic factor. Beriberi is common in those area where polished rice is eaten.
Beriberi Disease