1. Introduction1.1. Definition Beriberi is a severedeficiency in vitamin B1, otherwise known as thiamine deficiency. It is uncommontoday in the contemporary era (approx.1945 to present) and especially so indeveloped countries like Korea, however, because of its rarity it is oftenunidentified by cardiologists (Lee, et al.
, 2013). SynonymsBeriberi can also beknown as: thiamine deficiency, oriental beriberi, rice disease, occidentalberiberi, Ceylon sickness (United Nations High Commissioner for Refugees, 1999). 1.2. Background19thCentury Japanese NavyBeriberi was prevalentin the Japanese navy and possible deaths in the navy related to the diseasewere recorded from 1878 to 1886 by the vice director of the Navy MedicalBureau, Takaki Kanehiro (Bay, 2012). He suggested that many deaths ranging from0 to 57 each year can be accredited to a protein deficiency. Kanehiro’sfindings were rejected by the surgeon inspector general, Ishiguro Tadanori, thatargued beriberi is a contagious disease and not a consequence of dietary habits.It was not unreasonable to believe that beriberi was a contagious disease aslarge population of people were contracting the ‘contagious disease’.
Ofcourse, this was due to the Japanese ‘white rice diet’ which did not containenough thiamine. Eventually, Takaki’s theory of protein deficiency was acceptedas factual and was not far from the truth as protein foods are generally highin thiamine (Bay, 2012; United States Department of Agriculture, 2017). The Philippines and RobertR. Williams (1886-1965)Williams was the AmericanChemist who first synthesized thiamine (Williams & Cline, 1936). He studiedberiberi in the Philippines in 1910 and found that 40% of children aged 2 to 5months would die due to thiamine deficiency in Manila (Williams, 1961).
Additionally, he found that thiamine deficiency is the fourth highest cause Beriberi in animalsThiamine deficiency isalso evident in reptiles. A peer reviewed article demonstrates that feedingreptiles food that is high in anti-thiamine such as gold fish and fatheadminnow can lead to the reptile developing beriberi (Mans & Braun, 2014).The same article shows that the same effect can be seen in alligators and iguanaswhen they eat too much fish that are high in thiaminase (anti-thiaminecompound). They treat the deficiency with thiamine supplements and to preventberiberi in reptiles, they recommend that you feed them fish thawed slowly in arefrigerator so that the thiaminase in frozen fish is not activated which woulddestroy the thiamine in its diet.
Causeand effectCauseUnbalancedDiet – Obviouslythe main cause is a lack in vitamin B1 intake, where most of the time it is becauseof a diet that omits foods such as: wheat, brown rice, pork, beef, lentils orother high-in-thiamine foods (Bay, 2012). Anti-ThiamineCompounds – Somefoods contain anti-thiamine compounds which ‘destroy’ thiamine and can increasethe requirement for vitamin B1 (UNHCR, 1999). The UNHCR also explain that,thiaminase, found in the tissue of fish guts is an anti-thiamine which can leadto poisoning by eating a diet consisting of only rice and fish. Washingrice – It iscommon practise is many Asian cultures to clean rice multiple times.
However,washing rice will remove the outer layer, the pericarp, which contains importantnutrients e.g. vitamin B1 (Rosenau & Kendall, 1911).
An experimentinvolving chickens has shown that the chickens fed unpolished riced (unwashedrice) remained healthy while chickens fed polished rice were unhealthy andshowed symptoms of beriberi (Rosenau & Kendall, 1911). Lossof thiamine in food processing/storage– Thiamine is sensitive to heat, oxidising/reducing agents, neutral andalkaline conditions and ionizing radiation (UNHCR, 1999). UNHCR explainthiamine as being stable in a low pH environment, but it decomposes fromheating in non-acidic conditions. Additionally, thawing frozen foods slowly canresult in a loss of thiamine, but thawing quickly will reduce the amount of thiaminelost.Alcohol – A study of thiamine deficiency inrat test subjects revealed that the consumption of alcohol can lead to beriberisymptoms (He, 2007).
Alcoholism can lead to beriberi because the intestinal absorptionof thiamine is impaired by ethanol so that less thiamine passes into theenterocyte (Gastaldi, et al., 1989). Thus, even with a diet that provides adequatethiamine, an alcoholic would still be prone to beriberi.Effect In2009, African Union troops were found to have had an illness causing 4 deathsand 31 hospitalized (Watson, et al., 2011). They suffered from wet beriberi dueto an exclusive consumption of food provided to the troops. They obtainedsymptoms including: dyspnea, chest pain, palpitations, nausea, vomiting,abdominal pain and headache.Beriberican be wet or dry, they each have differing symptoms.
Wet beriberi is whenthere are predominant cardiac symptoms especially in young active males and isrelated to impaired carbohydrate metabolism, whereas dry beriberi is associatedwith damage to the peripheral nerves causing pain, vomiting, loss of musclefunction and difficulty in walking (Spinazzi 2010; Watson, et al., 2011).Acommon symptom of dry beriberi is partial paralysis, and this symptom isdiscovered to be exacerbated in wild birds. Vitamin B1 deficiency in full grownwild birds are found to have the symptoms: inability to fly, inability to walk,tremors, seizures, and death (Balk, et al., 2009). Balk’s journal article examinesthe idiopathic paralytic disease in wild birds from the Baltic sea area and theyconclude the disease as beriberi. 2.
2. Treatment/PreventingMeasures for BeriberiSupplements – Probably the most common andeffective way to treat beriberi. Thiamine is non-toxic even in large doses (Nguyen-Khoa,2017). 2.
5 to 5mg of thiamine daily for several days is recommended to treatthiamine deficiency, but this value can increase if the patient has amalabsorption syndrome or is pregnant (Nguyen-Khoa, 2017).Changeof diet – if possiblea change in diet would solve beriberi. However, in areas with low food securitylike impoverished third world countries, this option may not be available. Intakeof foods with proteins will help as protein foods generally are high inthiamine (Bay, 2012).Thawingfood quickly – Rapidthawing can help the denaturation of thaiminase and hence allow more thiamineto be digested (Mans & Braun, 2014). Mans & Braun also suggest thawing fishin hot water that is 80 degrees Celsius for 5 minutes.
Notwashing rice or using less chlorinated water – Washing rice with chlorinated water will result ina 65% loss of thiamine, whereas in distilled water there is a loss of 45% (Yagi& Itokawa, 1979). Ideally, you should not wash rice to obtain the most nutrientspossible, but if the rice is dirty with many impurities it is safer to wash therice.Lesseninganti-thiamine intake– foods containing anti-thiamine are: tea leaves, betel nuts, raw carp,herring, shellfish and fermented fish (UNHCR, 1999). Limiting the intake ofthese foods can help prevent thiamine deficiency.Eatingfoods enriched in thiamine (UNHCR, 1999).
2.3. Beriberi’sInfluence on Public HealthInGeneral PopulationsAnarticle shows that thiamine deficiency can be common in the north eastern partsof Thailand despite eating high-in-thiamine foods like glutinous rice, rawfermented fish and vegetables (UNHCR, 1999). The same article explains thatanti-thiamine factors can be the reason for these beriberi cases.InRefugee PopulationsRefugeeshave a low food security with a limited access to a wide variety of foods. Theyare often deficient in many vitamins and beriberi is common for refugees.
2.4. FutureBeriberiis not a major concern today, nor should it be. With the development ofthiamine supplements, the disease can be cured within several days (Nguyen-Khoa,2017). The largest issue here is not being able to diagnose a patient withthiamine deficiency as it is now a somewhat rare disease. Cases of thiaminedeficiency will undoubtedly surface now and again in low food security sitessuch as in 2009 with the African Union troops, although, as the treatment is easyand efficient, it should not be an issue in the future as it was in 19thcentury Japan where hundreds of deaths were recorded to be caused by beriberi (Watson,et al.
, 2011; Bay, 2012). 3. Conclusion