Beriberi

• ALSO KNOWN AS: Thiamine deficiency, vitamin B₁ deficiency
• ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, heart, muscles, nervous system
• CAUSES: Thiamine deficiency from chronic alcoholism, malnutrition, diuresis, dialysis, and high carbohydrate intake
• SYMPTOMS: Weakness, irritability, nausea, vomiting, tingling, loss of sensation in hands and feet, confusion, difficulty speaking or walking; may progress to coma and death
• DURATION: Chronic, sometimes fatal
• TREATMENTS: Thiamine hydrochloride, dietary changes

DEFINITION: A nutritional disease resulting from thiamine deficiency

Causes and Symptoms

Thiamine, one of the B vitamins, plays an important role in energy metabolism and tissue building. When there is not enough thiamine in the diet, these basic energy functions are disturbed, leading to problems throughout the body. There are two major manifestations of thiamine deficiency: cardiovascular disease (wet beriberi) and nervous system disease (dry beriberi). Each can be caused by chronic alcoholism, malnutrition, diuresis, dialysis, and high carbohydrate intake.

The accompanying symptoms of thiamine deficiency may include weakness, irritability, nausea, vomiting, tingling, or loss of sensation in the hands and feet (peripheral neuropathy). Progressed symptoms include mental confusion and difficulties speaking or walking; these are often the precursor symptoms leading to coma and/or death.

Treatment and Therapy

Thiamine hydrochloride is the initial treatment of choice for beriberi. Successful treatment reverses the deficiency and alleviates most of the symptoms. Severe deficiencies may be treated with high doses of thiamine given by muscular injection.

Alternative treatments stress a diet rich in foods that provide thiamine and other B vitamins, such as brown rice, whole grains, raw fruits and vegetables, legumes, nuts and seeds, and yogurt. Additional supplements of B vitamins, a multivitamin and mineral complex, and vitamin C are also recommended. A balanced diet containing all essential nutrients will prevent thiamine deficiency and the development of beriberi. People who consume large quantities of soda, pretzels, chips, candy, and high-carbohydrate foods made with unenriched flours may also need vitamin supplements to avoid thiamine deficiency.

Perspective and Prospects

The first clinical descriptions of beriberi were conducted by the Dutch physician Nicolaes Tulp around 1652. Tulp treated a young Dutchman who, upon returning from the East Indies, suffered from what the Indigenous people of the Indies called beriberi, or “the lameness.” Not until the early twentieth century did scientists discover that rice bran, the outer covering of white rice, actually contains something that prevents the disease, thiamine. In the 1920s, extracts of rice polishings were used to treat the disease.

Beriberi is fatal if left untreated. Most symptoms can be reversed, and full recovery is possible when thiamine levels are returned to normal and maintained with a balanced diet and vitamin supplements as needed.

Into the mid-2020s, thiamine deficiency remained a significant global health problem, especially in regions with high dependence on polished rice. In developed countries, cases were linked to alcohol use disorder, bariatric surgery, dialysis, and long-term parenteral nutrition. Severe deficiency can progress to Wernicke’s encephalopathy and Korsakoff syndrome, neurological complications that require urgent intravenous thiamine therapy, administered before glucose. Diagnosis often uses blood thiamine diphosphate testing and neuroimaging when neurological symptoms are present.

Bibliography:

Anderson, Jean, and Barbara Deskins. The Nutrition Bible. William Morrow, 1997.

Bouraghda, Mohamed Abed, et al. “Beriberi Disease: Forgotten but Not Gone!” Scholars Journal of Medical Case Reports, vol. 11, no. 2, Feb. 2023, pp. 189–192.

Habas, Elmukhtar, et al. "Wernicke Encephalopathy: An Updated Narrative Review." Saudi Journal of Medicine & Medical Sciences, vol. 11, no. 3, 2023, p. 193, doi.org/10.4103/sjmms.sjmms_416_22. Accessed 25 Aug. 2025.

Kliegman, Robert, and Waldo E. Nelson, editors. Nelson Textbook of Pediatrics. 19th ed., Saunders/Elsevier, 2011.

Rivlin, Richard. “Vitamin Deficiency.” In Conn’s Current Therapy, edited by Robert E. Rakel and Edward T. Bope. Saunders/Elsevier, 2007.

"Thiamin (Vitamin B1)." MedlinePlus, 15 June 2025, medlineplus.gov/druginfo/meds/a682586.html. Accessed 25 Aug. 2025.

Vorvick, Linda J. "Beriberi." MedlinePlus, 23 July 2024, medlineplus.gov/ency/article/000339.htm. Accessed 25 Aug. 2025.

Williams, Sue Rodwell, and Eleanor D. Schlenker. Essentials of Nutrition and Diet Therapy. 9th ed., Mosby/Elsevier, 2007.