Beriberi - definition, history, causes and symptoms

Beri-Beri - A serious illness
The disease beriberi has been known for over 4500 years, in ancient China as well as in biblical times and in ancient Rome and Greece. The ancient Egyptians reported people with paralyzed and decaying muscles, the Japanese feared the plague that transforms humans into living skeletons. In China, Beri-Beri destroyed heart functions, in short: the disease led to a cruel death in countless people.

contents

• definition
• Staggering like a sheep
• Japan's fight against the plague
• Kitchen leftovers and sick chickens
• The vitamins
• What do we need thiamine for??
• Eijkmann rejects the Nobel Prize
• Beriberi by mold?
• citreoviridin
• Mold or thiamine deficiency?
• Dry beriberi
• Moist beriberi
• Causes of beriberi
• When to the doctor?
• treatment

definition

Beriberi is considered classic avitaminosis, more specifically vitamin B1 deficiency. The disease occurs mainly in husked rice as the main nutrition, but also in alcoholics. The science history of the disease shows that it could not be just a vitamin deficiency.

In the form of a disease Beriberi occurs mainly in countries where peeled or polished rice is the main food. (Image: Mara Zemgaliete / fotolia.com)

Staggering like a sheep

The Dutchman Jacob de Bondt described in 1630 a widespread disease in Indonesia: The victims would therefore have a course "like sheep", ie shaky and with trembling knees. Therefore, the locals called the plague beriberi - meaning sheep.

It was a collective term for a variety of symptoms: some patients suffered from haggard limbs, others had swollen legs, others tormented diarrhea or constipation; Ill patients were paralyzed on the ground, and many died within a few days.

Japan's fight against the plague

In the 19th century, the previously strictly isolated island empire opened up to exchange with Europe. German-speaking and Japanese physicians tried with their different methods to treat Beriberi. However, since neither knew anything about the cause of the disease, Western doctors were as unsuccessful as their Japanese counterparts.

Most doctors thought that Beri-Beri was a virus or a bacterium. The Japanese Kanehiro Takaki doubted this, however, after he had examined ill soldiers of the Japanese Navy. As with scurvy, which was known since the 18th century as a condition caused by malnutrition, he suspected false food as a suspect.

At that time, as in many Asian countries, the ordinary diet of ordinary people in Japan consisted of husked rice. Takaki now had the crew of one ship continue to eat husked rice, and that of a second ship also received meat, vegetables, barley and fish. After nine months at sea, 161 of 376 sailors suffered from beriberi on the first ship, 25 died of it, and on the second ship only 14 fell ill.

Takaki had testified that the disease was related to the husked rice diet. But this discovery remained controversial. Takaki prevailed, however, and the Japanese army introduced his diet in the Navy. In six years, the Beriberi disease in Marines fell to zero by 40%. In 1890, the Japanese government passed a law that prescribed Takaki's mixture as a supply to soldiers.

The Dutch doctor Christiaan Eijkman recognized by an examination of chickens that the disease could be cured with unpeeled rice. (Image: emuck / fotolia.com)

Kitchen leftovers and sick chickens

It took 200 years for a Dutch doctor to systematically examine the disease. Christiaan Eijkman (1858-1930) came to Indonesia in 1886 and suspected a bacterium as a pathogen. He examined patients at the military hospital in Batavia and watched chickens in the courtyard of the hospital. The chickens also suffered from the disease after eating peeled rice from kitchen waste.

Eijkman rejected his bacterial theory and thought the disease would be related to rice. He made a study in which he let the chickens alternately peeled and unpeeled rice and found out: He could use rice husked to trigger the disease in the animals and healed with unpeeled rice again. His assistant Gerrit Grijns also recognized that meat and peas also defeated the disease.

The hypothesis was now that white rice lacked a substance that the nervous system needed existentially, but was present in the shell of the rice.

The vitamins

Umetaro Suzuki (1874-1943) discovered in 1910 the "anti beriberi factor" in the rice bowl. He called him Oryzanin. Casimir Funk in London isolated, independent of Suzuki, in 1911 a supposed "anti-Beriberi factor", but in fact was ineffective. However, his research led to the term "vital amine" for such existing in the body substances that prevented disease. This led to the term vitamins.

Robert Williams synthesized in 1936 the vitamin B1 (thiamine), the B.C.P. Jansen and W. Donath had previously isolated from rice grains. Beriberi is considered a deficiency of vitamin B1.

What do we need thiamine for??

For the body, vitamin B1 is necessary to convert carbohydrates and sugar. Vitamin B1 supports the supply of the body with energy.

The body needs vitamin B1 to turn the carbohydrates from food into energy. (Image: shidlovski / fotolia.com)

Eijkmann rejects the Nobel Prize

Eijkmann received in 1929 for his discoveries about the cause of beriberi the Nobel Prize for Medicine, more precisely "for his discovery of the antineuritic vitamin". It came to a scandal: Eijkmann did not accept the price. He said he did not believe in vitamin B1 deficiency as the cause of beriberi and would never have said so. Rather Beriberi is bound to the cooked rice diet and would not be present in other diets.

Old traditions confirmed his skepticism. So had the Chinese Chao-Yünan Fang already in the 7th century CE. Beriberi described so accurately that there was no doubt that it was the same disease - and at that time there had been no husked rice.

Japanese professors supported Eijkmann's doubts: Shibayama and Miyamoto reported numerous miners on Sunda Island Banka, many of whom fell ill with beri-beri even though they only ate unpeeled rice. There were even mines where workers would eat unpeeled rice and still have beriberi more often than miners who would eat shelled rice.

The thesis that suffering is not related to husked rice also confirms its spread in other Asian countries. In India, for example, people ate a lot more parboiled rice, which barely spread in China and Japan. In spite of an equally high proportion of rice in the diet, however, much fewer Indians fell ill with the disease. Conversely, Beriberi was rampant in the 1920s, when rice was exported from Japan to Burma, Thailand and the Philippines, even in those countries.

Beriberi by mold?

Eijkmann cited another important argument: Healthy soldiers died after eating rice in 48 hours. But that could not be due to malnutrition. In fact, diseases due to lack of specific vitamins and minerals are long term. A rapid progression of symptoms to death after eating and within a few hours is more typical of poisoning.

Eijkmann therefore suspected a neurotoxin as the cause of Beriberi. In question, for example, poisons of mold, which form on the rice. At the time, however, this thesis found little support, because medicine assumed that cooking destroys such poisons.

The Japanese scientist Kenji Uraguchia strengthened 1969 Eijkmanns guess: He discovered Penicillium citreoviride, a mold that grows on rice. This produces the neurotoxin Citreoviridin. It attacks nerve cells in the brain and spine and stops the energy supply of the tissue. That would also explain the extreme weakness of Beriberikranken.

A Japanese scientist discovered in the late 1960s, a mold that grows on rice. (Image: monkeyshishi08 / fotolia.com)

citreoviridin

The mold develops the poison increasingly at low temperatures and high humidity, as they are typical of northern Japan. Rice from this region was exported to many areas where beriberi was rampant.

The various symptoms of the disease could be explained by the different dosages of toxins produced by this fungus, depending on the climate.

Mold or thiamine deficiency?

Nevertheless, mold fungus as a cause and a lack of vitamin B1 are not mutually exclusive. An intake of vitamin B1 helps against beriberi. Just as various vitamins play a crucial role in the immune system, vitamin B1 could be the body's antidote to the poison citroviridin.

This would also explain why Beriberi occurs less frequently when eating husked rice, but not completely disappears: Thiamine would be a natural protection of the rice plant against mold, which can stem an infestation, but can not completely prevent it.

In any case, beriberi is extremely rare in countries where people are getting enough vitamins, such as bread or breakfast made from cereal products. Today, the condition also affects people who suffer from alcohol abuse and makes it difficult for the body to absorb and store thiamine.

Dry beriberi

The dry form of the disease is manifested by various nerve disorders such as lack of response to pain, double vision, disorientation, delusions and loss of memory. Confused thinking and fantasies that replace lost memories are typical.

Shortness of breath and fatigue are typical symptoms of the moist form of beriberi. (Image: Lydie stock / fotolia.com)

Moist beriberi

The main symptom of a wet beri beri are edema, especially in the legs, but also on the anus, in the face or on the trunk. Shortness of breath, shortness of breath and an accelerated pulse are also typical, as well as extensive neck arteries with visible pulse. The heart appears enlarged.

A patient with wet beriberi is in mortal danger, even if he looks as if he's okay. He can die of acute circulatory failure.

Causes of beriberi

Whether caused by a mold or not, the main reason that the disease breaks out is a lack of vitamin B1. Of course, thiamine is found in fresh fruits, milk, green vegetables, meat and wholemeal bread. A diet based primarily on shelled rice does not provide the body with vitamin B1.

Genetic causes are unlikely. Suffering occurs in people who have no family history of the disease. However, the disease can occur in people who naturally can not absorb vitamin B1. Here, the disease is actually different, and the question is whether it is the syndrome studied in Japan and Indonesia: people who have genetic problems taking in vitamin B1 develop deficiency symptoms over the years, and they do not fatten within less days at Beriberi.

Infants may suffer from vitamin B1 deficiency if the mother stores too little of it in her body, and the milk source is the baby's mother's milk. Chronic diarrhea can also lead to thiamine deficiency.

In addition to unpeeled rice, e.g. Legumes, sunflower seeds and eggs abundant vitamin B1. (Image: ratmaner / fotolia.com)

When to the doctor?

In the event of Beri Beri's disease, you should definitely consult a doctor simply because the symptoms are nonspecific in both the dry and wet forms of the disease. Nervous disorders and cardiac arrhythmia can have a lot of causes.

A doctor can also remedy other problems associated with thiamine deficiency. You should be suspected of taking Beri-Beri at the following risks if you exhibit the following symptoms: One-sided diet with husked rice, repeated diets associated with deficient vitamin supply, severe alcohol abuse.

It is not recommended to simply take vitamin B1 supplements without medical advice. If you do not suffer from a thiamine deficiency, you may be taking too much vitamin B1. However, overdoses increase blood sugar and can damage the heart and liver.

treatment

To treat or prevent the disease still means to provide the patients with vitamin B1. For example, the amount of rice in the diet must be reduced, and if people eat a lot of rice, they should resort to unpeeled and / or parboiled travel. Even a broken beri-beri does not have to be a deadly disease today.

A diet with fish and rice should at least be supplemented with other foods. Mussels, shrimp, and the raw meat of animals contains thiaminase, an enzyme that breaks down vitamin B1. Anyone who already suffers from a deficiency of vitamin B1 should temporarily give up fish.

In northern Japan, when the disease was rampant, people's diets were mostly rice and fish. The fish would thus have additionally caused a thiamine deficiency. (Somayeh Ranjbar)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

References:
http://www.who.int/nutrition/publications/en/thiamine_in_emergencies_eng.pdf
http://www.wiredhealthresources.net/resources/docs/79_16BeriberiThiamineDeficiency.pdf
http://www.medilexicon.com/dictionary/10005
https://medlineplus.gov/ency/article/000339.htm
https://scilogs.spektrum.de