Beri beri

What is beri beri

Beri beri is a condition of the nervous system caused by a lack of vitamin B1 (thiamin) in the diet.

Beri beri (also written beriberi) is a nutritional deficiency disease that only occurs when the diet is severely deficient in vitamin B1 (thiamin) over a long time.

In addition to being a nutritional deficiency disease, beri beri can be due to a genetic disorder which causes the body the not be able to absorb vitamin B1 from food, which is inherited from the parents.

Two types of beri beri

• Dry beri beri (endemic neuritis) – this type can affect the nervous tissue in the peripheral nervous system (it is also known as Wernicke-Korsakoff syndrome)
• Wet beri beri – this type affects the heart and cardiovascular system and can sometimes be fatal

Facts about Beri Beri

• Beri beri is basically non-existent in many parts of the world, because many foods that are processed are also normally enriched with vitamin B1 (thiamin)
• Beri beri is a nutrition deficiency disease which is caused by a lack of vitamin B1 (thiamin) in the diet
• People who drink excessively can be at risk of beri beri because they may not eat enough food
• Wet beri beri is very serious and can be fatal if it goes on undiagnosed for a long time
• Dry beri beri is not as serious, but it can still cause a number of symptoms
• Beri beri occurs more frequently in East Asian countries because they eat a lot of milled (white) rice, which has had most of the vitamin B1 (thiamin) removed, as it is in the outer coating of the rice
• Babies whose mothers have any type of vitamin B1 (thiamin) deficiency can develop and infantile form of beri beri
• Vitamin B1 (thiamin) was isolated in 1934
• Beri beri is also written as beriberi

Symptoms of beri beri

General symptoms of dry beri beri, which are normally easily reversible with vitamin B1 (thiamin) supplementation are:

• Abdominal pain or nausea
• Difficulty walking
• Irritability
• Lethargy
• Loss of appetite
• Loss of feeling (sensation) in hands and feet
• Mental confusion/speech difficulties
• Muscle damage with loss of muscle function of the lower legs
• Oedema (fluid retention)
• Poor concentration
• Severe muscle aches and pains
• Strange eye movements (nystagmus)
• Tingling in the limbs
• Vomiting

Later symptoms of dry beri beri, which may not be reversible are:

• Foot and hand paralysis
• Peripheral neuritis
• Coma

Ultimately, it can cause death.

Causes of beri beri

The main reason that beri beri occurs is through a long term deficiency of vitamin B1 (thiamin) in the diet.

Beri beri is a nutritional deficiency disease where there is a lack of vitamin B1 (thiamin) in the diet.

In rare cases, an inherited form of beri beri can occur, which is a genetic disorder that causes an inability to absorb vitamin B1 (thiamin) from the food that is eaten. This type of beri beri is extremely rare.

Prevention of beri beri

Non-preventable risk factors

Beri beri may be unpreventable in certain circumstances:

• Dialysis – this procedure can often cause a deficiency in all nutrients but especially of the water soluble ones like vitamin B1 (thiamin)
• Diuretics – long term use of diuretic drugs can cause a deficiency in all nutrients but especially of the water soluble ones like vitamin B1 (thiamin)
• Genetic disorder – in very rare cases, beri beri is caused by an inherited genetic disorder, which causes an inability to absorb vitamin B1 (thiamin) from the food eaten in the diet. People with this type of beri beri will require monitoring and intravenous supplementation to prevent deficiency symptoms
• Malnutrition – people who are not eating enough food will not be getting enough of all the nutrients required by the body (including vitamin B1) which means beri beri may develop
• Mother to child – if a pregnant woman has a severe enough deficiency of vitamin B1 (thiamin), it can possibly cause an infantile form beri beri in the baby. Pregnant women must ensure they have adequate intake of all the vitamins, minerals, amino acids and other nutrients, to ensure these nutrients are passed to their baby, to prevent risk of any type of nutritional deficiency, including infantile beri beri

Preventable risk factors

There are ways to prevent beri beri from occurring:

• Adequate nutrition – the way to prevent beri beri is to ensure there is adequate intake of foods rich in vitamin B1 (thiamin) in the diet. Beri beri does not often occur because most people will get enough vitamin B1 (thiamin) in their diet from the food they eat. For the small group of people at risk of developing beri beri, regular blood tests to check vitamin B1 (thiamin) levels are the only way to prevent this nutritional deficiency from developing into beri beri in most cases
• Alcohol abuse – people who drink heavily may not be getting enough vitamin B1 (thiamin) in their diet and are the main group of people who are at most risk for developing beri beri. People who drink excessively need to have blood tests to monitor their level of the nutrients and may require supplementation (administered intravenously by their doctor or nurse) to prevent nutritional deficiency conditions such as beri beri
• Baby formula – babies who are only fed baby formula can get beri beri if it does not contain adequate levels of vitamin B1 (thiamin) and while this is not a regular occurrence, it can happen
• Extreme dieting – people who go on extreme diets that restricts their food intake and especially if they restrict the amounts of foods from the different food groups, can become deficient in vitamin B1 (thiamin) and if the extreme diet continues long term, beri beri can develop

Complications of beri beri

There are a number of very serious complications of both wet and dry beri beri, especially if the deficiency of vitamin B1 (thiamin) has been undiagnosed for a long duration without adequate treatment.

Complications of dry beri beri

• Memory loss – if the beri beri is not caught early enough and vitamin B1 (thiamin) administered intravenously, the memory loss symptoms can become permanent, even with treatment, as the damage to the central nervous system tissue may be irreversible. If the dry beri beri is treated early, memory loss can be prevented
• Paralysis – if the beri beri is not caught early enough and vitamin B1 (thiamin) administered intravenously, paralysis of the legs (or arms) can become permanent, even with treatment, as the damage to the peripheral nervous system tissue may be irreversible. If the dry beri beri is treated early, paralysis can be prevented
• Psychosis – if the beri beri is not treated quickly with intravenous vitamin B1 (thiamin) the psychosis symptoms can becomes permanent, even with treatment at a later stage. If the dry beri beri is treated early, psychosis can be prevented

Complications of wet beri beri

• Heart failure – the most serious complication of wet beri beri is cardiomyopathy, which includes heart enlargement and finally heart failure. If heart failure has already occurred due to untreated wet beri beri, the prognosis is very poor, with coma and death being the final prognosis of this nutritional deficiency. If wet beri beri is diagnosed and treated early enough, the heart problems can be reversed, so treatment is imperative to prevent serious complications

When to see a doctor about beri beri

People who have any of the symptoms associated with beri beri need to see their doctor to have a blood test in order to confirm (or rule out) beri beri.

People with an existing vitamin B1 (thiamine) deficiency, need to see their doctor on a regular basis in order to have regular blood tests to monitor their vitamin B1 (thiamine) levels to determine the response to treatment for beri beri – whether or not it has been successful in improving vitamin B1 (thiamin) levels.

Diagnosis of beri beri

Initial diagnosis of beri beri includes the following tests:

• Medical history – the doctor will ask a series of question about the onset (start) of symptoms, how severe the symptoms are and the duration of symptoms. The doctor will also ask some questions about alcohol intake, dietary intake and if the woman is breastfeeding, questions about breastfeeding and bottle feeding
• Physical examination – the doctor will perform a general physical examination to determine if there are any obvious symptoms of beri beri, such as swelling in the legs, fast heartbeat (arrhythmia) and veins that stick out quite obviously on the neck, which are all signs of congestive heart failure. In addition to this, the doctor may test the reflexes, request you to walk or perform some other coordination tasks, to test your coordination, which if they are not functioning properly could be a sign of dry beri beri

Diagnostic tests

If beri beri is suspected, then the following diagnostic tests may also be requested to confirm (or rule out) diagnosis:

• Blood test – a blood test will be requested to determine the blood levels of vitamin B1 (thiamin) and most likely the to look at the health and the numbers of both of the red blood cells and the white blood cells too
• Urine test – a urine test will be requested to determine if vitamin B1 (thiamin) is passing through urine in excessive amounts, to test if you are excreting too much of it and not absorbing enough in the intestines. This test can help the doctor find out if you have a problem with digesting and absorbing vitamin B1 (thiamin)

Conventional treatment of beri beri

Conventional treatment of beri beri consists of the following.

Medication

This is the main way to reverse any potential adverse health symptoms of beri beri:

• Heart medication – if the beri beri diagnosed is wet beri beri and the condition has been undiagnosed for a long time, the heart function may be compromised, which may require not just vitamin B1 (thiamin), but heart medications such as digoxin,
• Pain relief – depending on the severity of any neurological symptoms, pain relief medications may be given to relieve pain in the extremities, due to peripheral neuropathy
• Vitamin B1 (thiamin) – depending on the severity of the beri beri, vitamin B1 (thiamin) will be given either intravenously (injected into a vein) or provided in tablets to take orally or a combination of both. If the deficiency is mild (or borderline), then the doctor will recommend vitamin B1 (thiamin) supplements to be taken for a specific period at a specific dosage. If the deficiency is rather severe, vitamin B1 (thiamin) will be provided intravenously at a specific dosage for a specified amount of time
• B vitamins – depending on the results of the blood tests, the other B vitamins may also be recommended to be taken in supplement (tablet) form as well
• Other vitamins – depending on the results of the blood tests, other vitamins may also be recommended to be taken in supplement (tablet) form as well. This is most often the treatment for people whose diet is very deficient in many of the nutrients and who may need supplementation

Dietary modifications

In addition to the vitamin B1 (thiamin) supplementation either intravenously or in tablet form, the doctor may also recommend the diet to be supplemented with increased intake of foods rich in vitamin B1 (thiamin) to help with absorption, further decrease the deficiency in this nutrient and reverse the symptoms.

Alternative / complementary treatment of beri beri

The alternative/complementary treatment of beri beri is the same as the conventional treatment.

People who have a serious deficiency in vitamin B1 (thiamin) must see their doctor to have vitamin B1 (thiamin) injected intravenously (as this is the best way to provide higher doses of this vitamin, quickly and effectively, bypassing the stomach and intestines) to prevent any worsening of symptoms and possible complications.

Herbs

There are no herbs which are useful for treating beri beri.

Vitamins

There is one main vitamin which is useful for treating beri beri:

• Vitamin B1 (thiamin) – a deficiency of vitamin B1 (thiamin) is the sole cause of beri beri and people who are at risk of having a deficiency in this vitamin should be taking supplements (as recommended by their doctor) or to have vitamin B1 (thiamin) injected intravenously. People at risk of deficiency must have a blood test and not self prescribe this vitamin
• B vitamins – the other B vitamins may be recommended as they help each other function better. A doctor will recommend the best treatment option, which may include either a supplement (or an intravenous injection) with the other B vitamins too

Minerals

There are no minerals which are useful for treating beri beri.

Other nutrients

There are no other nutrients which are useful for treating beri beri.

Dietary modifications

There are some useful dietary modifications to help avoid beri beri or reduce worsening of symptoms:

• Eat foods high vitamin B1 (thiamin) – the diet should be modified to include foods rich in vitamin B1 (thiamin), as an adjunct to any medication (supplements and/or intravenous injection) so that symptoms may be reduced and complications can be prevented. Foods that are rich in vitamin B1 are: Legumes (chickpeas, beans, soya), liver, nuts (almonds, brazil nuts, hazelnuts, peanuts, pecan nuts, walnuts), seeds (pumpkin, sesame, sunflower), pork, wheatgerm, wholegrains
• Healthy diet – since beri beri is predominantly a nutritional disorder, which occurs when there is a deficiency of vitamin B1 (thiamin) it is highly recommended to eat a variety of foods, which are rich in vitamins, minerals and the amino acids, to help reduce the risk of any other nutritional deficiencies

Lifestyle modifications

There are no lifestyle modifications which are useful for treating beri beri.

Alternative treatments

There are no other alternative treatments which are useful for treating beri beri.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with beri beri

Self care

People who are living with beri beri, can help improve their condition with the following strategies.

• Baby formula – mothers who are feeding their baby with baby formula need to ensure that it contains adequate levels of not just vitamin B1 (thiamin), but also all the other vitamins, minerals and amino acids to ensure their baby is not going to be at risk of infantile beri beri or any other nutritional deficiency
• Breastfeeding – mothers who are breastfeeding their baby need to make sure they are getting adequate levels of vitamin B1 (thiamin) in their diet to ensure their baby does not develop infantile beri beri (or any other nutritional deficiency)
• Healthy diet – while you can get supplements with all the appropriate vitamins, minerals and amino acids, it does not replace a healthy diet. You must make sure that you have a healthy diet, which includes lots of fresh fruit and vegetables each day, legumes (chickpeas, beans, soya), wholegrains, nuts and seeds, some low fat dairy, fish 2-3 times a week and some red meat 2-3 times a week, to help prevent any other nutritional deficiencies
• Heart medication and/or surgery – people who have very severe beri beri that has been undiagnosed for a long time, may develop heart failure which requires heart surgery and/or heart medications to prevent death. Your doctor will advise you on the type of medication you need to take and if surgery is an option for you. You will also need to see your doctor regularly to have tests and monitor your condition
• Limit alcohol – excessive alcohol intake is associated with increased risk of beri beri as most of the vitamins and minerals in the food you eat (if you do eat properly) will usually be excreted through the urine and this means you are not absorbing enough for good health and beri beri will not be the only nutritional deficiency you will develop. If you drink a lot of alcohol, you must decrease your intake to avoid complications of beri beri, including paralysis, coma and death
• Pain medication – some people may have permanent peripheral nerve problems in their extremities (hands and/or feet), which will require pain medication to help manage the pain that is associated with these types of continuing symptoms. Pain medications will normally be prescribed at low dosage and can include: non-steroidal anti-inflammatory drugs (NSAIDs), anti-depressants, anti-convulsants
• Regularly consult a doctor – you will need to visit your doctor on a regular basis, especially if you are receiving intravenous injections of vitamin B1 (thiamin), which your doctor (or nurse) will administer on a regular basis. Your doctor may allow you or your partner/family member to administer those injections instead. If your condition is not so serious, you may be recommended to take vitamin B1 (thiamin) supplements with or without the other B vitamins and this depends on the results of the initial blood test. In addition to this, you will need to have follow-up blood test(s) to determine if your treatment has been successful and further follow-up, as required
• Vitamin B1 supplements – your doctor will recommend you have either intravenous injections, oral supplements (tablets) or a combination of both to treat your condition. You must continue with treatment to prevent worsening of symptoms or any further complications of your condition

Caring for someone with beri beri

Partner

If your partner has beri beri, you may be able to help them through the following strategies:

• Avoid alcohol – if your partner drinks at levels that are higher than the recommended levels, you could try to let them know how the excessive alcohol consumption has led to development of beri beri, which can be serious and life threatening if not treated promptly. If this does not work well, your partner’s doctor should discuss the seriousness of their condition
• Healthy diet – your partner needs to ensure they eat a healthy diet which includes plenty of fresh fruit and vegetables, legumes (chickpeas, beans, soya), nuts, seeds, wholegrains, some fish, poultry and red meat each week, to help reduce the risk of worsening of symptoms and to reduce possible complications
• Intravenous injections – your partner’s doctor may request you help administer the vitamin B1 (thiamin) intravenous injections to reduce the visits to the doctor, if it can be performed at home. You will be given some instructions by the doctor when and how the injections should be administered

Friends

If your friend has beri beri, you may be able to help them through the following strategies:

• Avoid alcohol – try to help your friend avoid alcohol by choosing social outings that do not include any type of alcohol (anything outdoors or sporty should be fine)

Parents

If your child has beri beri, you may be able to help them through the following strategies:

• Adequate intake of foods rich in vitamin B1 – you will need to ensure that your child has adequate intake of foods rich in vitamin B1 (thiamin) to prevent worsening of symptoms or risk of possible complications. The foods that are rich in vitamin B1 (thiamin) are: legumes (chickpeas, beans, soya), liver, nuts (almonds, brazil nuts, hazelnuts, peanuts, pecan nuts, walnuts), seeds (pumpkin, sesame, sunflower), pork, wheatgerm, wholegrains
• Baby formula – if your baby has infantile beri beri and you are not breastfeeding, your doctor may recommend you use a different type of baby formula or may also recommend vitamin B1 (thiamin) supplements to reverse the condition and prevent complications
• Breastfeeding – you may be required to either receive some vitamin B1 (thiamin) intravenously or to take some in supplement (tablet) form, depending on the degree of deficiency and your own symptoms. This is the best way to prevent your baby from getting further deficient and developing worsening infantile beri beri
• Healthy diet – you need to ensure your child eats a healthy diet which includes plenty of fresh fruit and vegetables, legumes (chickpeas, beans, soya), nuts, seeds, wholegrains, some fish, poultry and red meat each week, to help reduce the risk of worsening of symptoms and to reduce possible complications
• Pain medication – if your child has had beri beri for a long time, which has been undiagnosed, this could lead to potential serious complications such as peripheral neuropathy (pain in the extremities), which may require pain relief medication to reduce these symptoms. You need to make sure you are aware of the dosages and timings of medication so that your child does not take too much of this type of medicine, as it can be dangerous. You also need to monitor your child’s side effects from these medications and inform your child’s doctor if they become too unwell

References

Last reviewed and updated: 14 May 2024