OF NEW SOUTH WALES
of Public Health and Community Medicine
Nutrition and Health
Beriberi is a severe
deficiency in vitamin B1, otherwise known as thiamine deficiency. It is uncommon
today in the contemporary era (approx.1945 to present) and especially so in
developed countries like Korea, however, because of its rarity it is often
unidentified by cardiologists (Lee, et al., 2013).
Beriberi can also be
known as: thiamine deficiency, oriental beriberi, rice disease, occidental
beriberi, Ceylon sickness (United Nations High Commissioner for Refugees, 1999).
Century Japanese Navy
Beriberi was prevalent
in the Japanese navy and possible deaths in the navy related to the disease
were recorded from 1878 to 1886 by the vice director of the Navy Medical
Bureau, Takaki Kanehiro (Bay, 2012). He suggested that many deaths ranging from
0 to 57 each year can be accredited to a protein deficiency. Kanehiro’s
findings were rejected by the surgeon inspector general, Ishiguro Tadanori, that
argued beriberi is a contagious disease and not a consequence of dietary habits.
It was not unreasonable to believe that beriberi was a contagious disease as
large population of people were contracting the ‘contagious disease’. Of
course, this was due to the Japanese ‘white rice diet’ which did not contain
enough thiamine. Eventually, Takaki’s theory of protein deficiency was accepted
as factual and was not far from the truth as protein foods are generally high
in thiamine (Bay, 2012; United States Department of Agriculture, 2017).
The Philippines and Robert
R. Williams (1886-1965)
Williams was the American
Chemist who first synthesized thiamine (Williams & Cline, 1936).
Beriberi in animals
Thiamine deficiency is
also evident in reptiles. A peer reviewed article demonstrates that feeding
reptiles food that is high in anti-thiamine such as gold fish and fathead
minnow can lead to the reptile developing beriberi (Mans & Braun, 2014).
The same article shows that the same effect can be seen in alligators and iguanas
when they eat too much fish that are high in thiaminase (anti-thiamine
compound). They treat the deficiency with thiamine supplements and to prevent
beriberi in reptiles, they recommend that you feed them fish thawed slowly in a
refrigerator so that the thiaminase in frozen fish is not activated which would
destroy the thiamine in its diet.
Diet – Obviously
the main cause is a lack in vitamin B1 intake, where most of the time it is because
of a diet that omits foods such as: wheat, brown rice, pork, beef, lentils or
other high-in-thiamine foods (Bay, 2012).
Compounds – Some
foods contain anti-thiamine compounds which ‘destroy’ thiamine and can increase
the 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 lead
to poisoning by eating a diet consisting of only rice and fish.
rice – It is
common practise is many Asian cultures to clean rice multiple times. However,
washing rice will remove the outer layer, the pericarp, which contains important
nutrients e.g. vitamin B1 (Rosenau & Kendall, 1911). An experiment
involving chickens has shown that the chickens fed unpolished riced (unwashed
rice) remained healthy while chickens fed polished rice were unhealthy and
showed symptoms of beriberi (Rosenau & Kendall, 1911).
of thiamine in food processing/storage
– Thiamine is sensitive to heat, oxidising/reducing agents, neutral and
alkaline conditions and ionizing radiation (UNHCR, 1999). UNHCR explain
thiamine as being stable in a low pH environment, but it decomposes from
heating in non-acidic conditions. Additionally, thawing frozen foods slowly can
result in a loss of thiamine, but thawing quickly will reduce the amount of thiamine
Alcohol – A study of thiamine deficiency in
rat test subjects revealed that the consumption of alcohol can lead to beriberi
symptoms (He, 2007). Alcoholism can lead to beriberi because the intestinal absorption
of thiamine is impaired by ethanol so that less thiamine passes into the
enterocyte (Gastaldi, et al., 1989). Thus, even with a diet that provides adequate
thiamine, an alcoholic would still be prone to beriberi.
2009, African Union troops were found to have had an illness causing 4 deaths
and 31 hospitalized (Watson, et al., 2011). They suffered from wet beriberi due
to an exclusive consumption of food provided to the troops. They obtained
symptoms including: dyspnea, chest pain, palpitations, nausea, vomiting,
abdominal pain and headache.
can be wet or dry, they each have differing symptoms. Wet beriberi is when
there are predominant cardiac symptoms especially in young active males and is
related to impaired carbohydrate metabolism, whereas dry beriberi is associated
with damage to the peripheral nerves causing pain, vomiting, loss of muscle
function and difficulty in walking (Spinazzi 2010; Watson, et al., 2011).
common symptom of dry beriberi is partial paralysis, and this symptom is
discovered to be exacerbated in wild birds. Vitamin B1 deficiency in full grown
wild 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 examines
the idiopathic paralytic disease in wild birds from the Baltic sea area and they
conclude the disease as beriberi.
Measures for Beriberi
Supplements – Probably the most common and
effective 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 treat
thiamine deficiency, but this value can increase if the patient has a
malabsorption syndrome or is pregnant (Nguyen-Khoa, 2017).
of diet – if possible
a change in diet would solve beriberi. However, in areas with low food security
like impoverished third world countries, this option may not be available. Intake
of foods with proteins will help as protein foods generally are high in
thiamine (Bay, 2012).
food quickly – Rapid
thawing can help the denaturation of thaiminase and hence allow more thiamine
to be digested (Mans & Braun, 2014). Mans & Braun also suggest thawing fish
in hot water that is 80 degrees Celsius for 5 minutes.
washing rice or using less chlorinated water – Washing rice with chlorinated water will result in
a 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 nutrients
possible, but if the rice is dirty with many impurities it is safer to wash the
– foods containing anti-thiamine are: tea leaves, betel nuts, raw carp,
herring, shellfish and fermented fish (UNHCR, 1999). Limiting the intake of
these foods can help prevent thiamine deficiency.
foods enriched in thiamine (UNHCR, 1999).
Influence on Public Health
article shows that thiamine deficiency can be common in the north eastern parts
of Thailand despite eating high-in-thiamine foods like glutinous rice, raw
fermented fish and vegetables (UNHCR, 1999). The same article explains that
anti-thiamine factors can be the reason for these beriberi cases.
have a low food security with a limited access to a wide variety of foods. They
are often deficient in many vitamins and beriberi is common for refugees.
is not a major concern today, nor should it be. With the development of
thiamine supplements, the disease can be cured within several days (Nguyen-Khoa,
2017). The largest issue here is not being able to diagnose a patient with
thiamine deficiency as it is now a somewhat rare disease. Cases of thiamine
deficiency will undoubtedly surface now and again in low food security sites
such as in 2009 with the African Union troops, although, as the treatment is easy
and efficient, it should not be an issue in the future as it was in 19th
century Japan where hundreds of deaths were recorded to be caused by beriberi (Watson,
et al., 2011; Bay, 2012).
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