What vitamins are lacking in beriberi?

According to StatPearls, vitamin B1, also known as thiamine, is the primary nutrient lacking in beriberi, which is classified as a water-soluble B vitamin. This severe deficiency can manifest with distinct symptoms impacting the nervous system, cardiovascular system, or a combination of both.

Quick Summary

A severe thiamine (vitamin B1) deficiency is the root cause of beriberi, leading to different forms of the disease affecting the nervous system (dry beriberi) and cardiovascular system (wet beriberi).

Key Points

• Single Vitamin Deficiency: Beriberi is exclusively caused by a severe lack of thiamine, also known as vitamin B1.

• Dual Impact: The deficiency affects either the cardiovascular system (wet beriberi) or the nervous system (dry beriberi).

• At-Risk Groups: Individuals with alcohol use disorder, those on diets lacking thiamine (like polished white rice), and bariatric surgery patients are most vulnerable.

• Preventable and Treatable: The condition is easily prevented with a healthy diet and effectively treated with thiamine supplements, often alongside a multivitamin.

• Reversible Damage: With early treatment, much of the damage to the heart and nerves can be reversed, but permanent damage is possible if treatment is delayed.

• Infantile Risk: Infants exclusively breastfed by a thiamine-deficient mother are at risk for a specific form of the disease.

The Primary Vitamin: Thiamine (Vitamin B1)

Beriberi is fundamentally a severe deficiency of thiamine, or vitamin B1, a water-soluble vitamin essential for human metabolism. Thiamine plays a crucial role as a coenzyme in the metabolism of carbohydrates, fats, and proteins, and is vital for proper nerve and heart function. When thiamine stores in the body are depleted, which can happen in as little as 2 to 3 weeks with inadequate intake, symptoms begin to appear.

Unlike fat-soluble vitamins, the body's storage of water-soluble vitamins like thiamine is limited, requiring a consistent and regular dietary intake. The lack of thiamine disrupts metabolic processes, leading to the buildup of certain substances like pyruvate and lactate, which can cause damage to various organ systems. Early detection and treatment with thiamine supplements can lead to a quick and often dramatic recovery.

The Two Main Types of Beriberi

Beriberi symptoms vary depending on the affected body system, leading to two primary classifications in adults: dry beriberi and wet beriberi.

Dry Beriberi (Nervous System)

Dry beriberi affects the nervous system, leading to nerve damage and a range of neurological symptoms. This form often occurs in cases of poor caloric intake and lower physical activity.

• Peripheral Neuropathy: Symmetrical impairment of sensory and motor functions in the extremities, especially in the distal lower limbs, resulting in numbness, tingling, and pain.
• Muscle Atrophy: Weakness and wasting away of muscles, particularly in the legs, which can lead to difficulty walking or even paralysis.
• Wernicke-Korsakoff Syndrome: A severe manifestation of thiamine deficiency, particularly in those with chronic alcohol use disorder, that involves brain abnormalities. Wernicke encephalopathy leads to confusion, eye movement problems (nystagmus), and difficulty walking, while Korsakoff psychosis is characterized by memory loss and confabulation.

Wet Beriberi (Cardiovascular System)

Wet beriberi impacts the cardiovascular system and is considered a medical emergency. It involves heart dysfunction and can rapidly progress to heart failure.

• Rapid Heart Rate: The heart beats faster and works harder to compensate for the body's needs.
• Shortness of Breath: Occurs during physical activity or even when resting, including waking up at night short of breath.
• Fluid Accumulation (Edema): Swelling of the lower legs and feet, and sometimes fluid in the lungs, due to the heart's inability to pump blood effectively.
• Congestive Heart Failure: The heart's increased workload and subsequent injury can lead to severe heart failure.

Related Vitamin Deficiencies

While thiamine is the key vitamin lacking in beriberi, it's important to note that nutrient deficiencies often coexist. People with risk factors for beriberi, such as those with malnutrition or alcohol use disorder, may also lack other vital nutrients. Because of this, treatment often includes a multivitamin supplement, ensuring that any related deficiencies, especially other B vitamins, are addressed.

Who is at Risk for Beriberi?

Beriberi is rare in developed countries where food fortification is common. However, several populations remain at high risk.

• Alcohol Misuse: Heavy alcohol consumption impairs the body's ability to absorb and store thiamine.
• Diets of Refined Carbohydrates: Diets consisting primarily of processed white rice or white flour, which lack thiamine, are a major risk factor.
• Bariatric Surgery: Surgical procedures for weight loss can interfere with nutrient absorption, including thiamine.
• Hyperemesis Gravidarum: Extreme and prolonged nausea and vomiting during pregnancy can lead to severe malnutrition and thiamine deficiency.
• Dialysis: Undergoing kidney dialysis increases the risk of nutrient loss.
• Infants: Babies exclusively breastfed by a mother who is thiamine deficient are at risk for infantile beriberi.

A Comparison of Wet vs. Dry Beriberi

Feature	Wet Beriberi	Dry Beriberi
Primary System Affected	Cardiovascular System	Nervous System
Key Symptoms	Rapid heart rate, shortness of breath, swollen legs (edema)	Numbness, tingling, paralysis in lower legs, muscle wasting
Associated Condition	Congestive Heart Failure, high-output heart failure	Peripheral Neuropathy, Wernicke-Korsakoff Syndrome
Speed of Onset	Can be acute and life-threatening, developing rapidly	Can develop over a longer period, often with vaguer initial symptoms
Main Threat	Heart failure and shock	Permanent nerve and brain damage if untreated

Treatment and Prevention of Beriberi

Fortunately, beriberi is highly treatable, especially with early intervention.

Treatment

The goal of treatment is to restore thiamine levels in the body.

1. Thiamine Supplementation: Mild cases may be treated with oral supplements, while more severe cases require intravenous or intramuscular injections of thiamine.
2. Multivitamins: Other B vitamins are often included in treatment to address potential coexisting deficiencies.
3. Balanced Diet: Following treatment, patients must adopt a diet rich in thiamine to prevent recurrence.

Prevention

Preventing beriberi hinges on a balanced diet rich in thiamine.

Thiamine-Rich Foods

• Pork and Fish
• Beans, Legumes, and Lentils
• Whole Grains and Nuts
• Seeds (e.g., Sunflower Seeds)
• Fortified Cereals and Bread
• Certain Vegetables (e.g., asparagus, spinach)

For at-risk individuals, such as those with alcohol dependence or after bariatric surgery, prophylactic supplementation may be recommended.

Conclusion

Beriberi is a serious but preventable and treatable disease caused by a deficiency of vitamin B1, or thiamine. By understanding the vitamin lacking in beriberi, its symptoms, and the risk factors involved, individuals can take proactive steps to ensure adequate thiamine intake through a balanced diet, including fortified foods. Early medical consultation for symptoms, especially those affecting the heart and nervous system, is critical for prompt and successful treatment to reverse damage and avoid long-term complications. For a more detailed medical overview of the condition, consider consulting resources from trusted medical providers such as Medscape.

Frequently Asked Questions

What is the main vitamin deficiency that causes beriberi?

The main vitamin deficiency that causes beriberi is a lack of thiamine, or vitamin B1.

What is the difference between wet beriberi and dry beriberi?

Wet beriberi primarily affects the cardiovascular system, leading to heart failure symptoms. Dry beriberi affects the nervous system, causing nerve damage and neurological symptoms.

Who is at the highest risk for developing beriberi?

High-risk individuals include those with alcohol use disorder, people whose diet consists mainly of refined carbohydrates like polished rice, and patients who have undergone bariatric surgery.

Can diet prevent beriberi?

Yes, consuming a healthy, balanced diet rich in thiamine-containing foods, such as pork, legumes, and whole grains, can prevent beriberi.

How is beriberi typically treated?

Treatment involves replacing the lacking thiamine, either through oral supplements for milder cases or injections for more severe deficiencies. A multivitamin is often also prescribed.

Are there other related vitamin deficiencies in beriberi?

While thiamine is the key deficiency, patients with malnutrition or alcohol dependence may have other coexisting B vitamin deficiencies, which is why a multivitamin is often recommended.

What are the long-term effects of untreated beriberi?

If untreated, beriberi can be fatal due to heart failure or cause permanent nerve and brain damage, especially in cases that progress to Wernicke-Korsakoff syndrome.