Beriberi is a disease caused by a deficiency of thiamine (vitamin B1) that affects many systems of the body, including the muscles, heart, nerves, and digestive system. Beriberi literally means, "I can’t, I can’t" in Singhalese, which reflects the crippling effect it has on its victims.
In adults, there are different forms of beriberi, classified according to the body systems most affected. The dry beriberi involves the nervous system; while wet beriberi affects the heart and circulation. However both types usually occur in the same patient, with one set of symptoms predominating. A less common form of cardiovascular or wet beriberi is known as "shoshin." This condition involves a rapid appearance of symptoms and acute heart failure. It is highly fatal and is known to cause sudden death in young whose diet consists of white rice.
Cerebral beriberi, also known as Wernicke-Korsakoff syndrome, usually occurs in chronic alcoholics and affects the central nervous system (brain and spinal cord). It can be caused by a situation that aggravates a chronic thiamine deficiency, like an alcoholic indulgency or severe vomiting. Infantile beriberi is seen in breastfed infants of thiamine-deficient mothers, who live in developing nations like ours. Thiamine is one of the B vitamins and plays an important role in energy metabolism and tissue building. It combines with phosphate to form the coenzyme thiamine pyrophosphate (TPP), which is essential in reactions that produce energy from glucose or that converts glucose to fat for storage in the tissues. When there is not enough thiamine in the diet, these basic energy functions are disturbed, leading to problems throughout the body.
Special situations, such as an over-active metabolism, prolonged fever, pregnancy, and breast-feeding, can increase the body’s thiamine requirements and lead to symptoms of deficiency, hence the importance of providing surplus vitamin B resourceful foods to pregnant women becomes so important. Extended periods of diarrhea or chronic liver disease can result in the body’s inability to maintain normal levels of many nutrients, including thiamine. Other persons at risk are patients with kidney failure on dialysis (a form of cleaning the kidney of poisonous substances which is usually accompanied by loss of essential body nutrients) and those with severe digestive problems who are unable to absorb nutrients.
Alcoholics are susceptible because they may substitute alcohol for food and their frequent intake of alcohol decreases the body’s ability to absorb thiamine, as we all might know that this is a common practice in the Rwandans society who likes drinking a lot and don’t eat, can you remember an old Kinyarwanda slogan saying that; ‘impfura iranywa ntabgo irya’, literally meaning that the wise drinks but do not eat. This is a dangerous culture which has to be changed if one wants to live longer, because we become healthy when we eat and drink health.
This disease may result into gastrointestinal as well as Central nervous system squeal for example, when the cells of the smooth muscles in the digestive system and glands do not get enough energy from glucose, they are unable to produce more glucose from the normal digestion of food. There is a loss of appetite, indigestion, severe constipation, and a lack of hydrochloric acid in the stomach. Glucose is essential for the central nervous system to function normally. Early deficiency symptoms are fatigue, irritability, and poor memory. If the deficiency continues, there is damage to the peripheral nerves that causes loss of sensation and muscle weakness, which is called peripheral neuropathy. The legs are most affected. The toes feel numb and the feet have a burning sensation; the leg muscles become sore and the calf muscles cramp. The individual walks unsteadily and has difficulty getting up from a squatting position. Eventually, the muscles shrink (atrophy) and there is a loss of reflexes in the knees and feet; the feet may hang limp (foot drop).
Other systems most affected are cardiovascular and musculoskeletal systems, in that there is a rapid heartbeat and sweating. Eventually the heart muscle weakens. Because the smooth muscle in the blood vessels is affected, the arteries and veins relax; causing swelling, known as oedema, in the legs, also there is widespread muscle pain.
Infants who are breast fed by a thiamine-deficient mother usually develop symptoms of deficiency between the second and fourth month of life. They are pale, restless, and unable to sleep, prone to diarrhea, and have muscle wasting and edema in their arms and legs. They have a characteristic, sometimes silent, cry and develop heart failure and nerve damage.
It is common in parts of Southeast Asia, where white rice is the main food. In the United States beriberi is primarily seen in people with chronic alcoholism and in Rwanda, it is common in people who take a lot of alcohol and who have little time to pay for food.
Beriberi puzzled medical experts for years as it ravaged people of all ages in Asia. Doctors thought it was caused by something in food. Not until the early 1900s did scientists discover that rice bran (fiber or cellulose), the outer covering that was removed to create the polished white rice preferred by Asians, actually contained something that prevented the disease. Thiamine was the first vitamin identified and in the 1920s, extracts of rice polishings were used to treat the disease.