Beri Beri and Pellagra: Deficiency of Vitamins B1, B3

Vitamin B1, also known as thiamine, and vitamin B3, also known as niacin, are both water-soluble vitamins (see ‘The Importance of B Vitamins’).

Vitamin B1 is found in whole grains, as well as yeast, liver, eggs, nuts, legumes (peas and beans), cauliflower, potatoes and oranges. Vitamin B3 is found in meat, yeast, wheat germ and dairy products. Deficiencies in vitamin B1 and vitamin B3 are often seen in people with a generally poor diet, or who rely on a single foodstuff as a staple.

Vitamin B1 Deficiency and Beri Beri

Primary vitamin B1 deficiency is caused by a lack of vitamin B1 in the diet, and is often seen in countries where the main diet is polished rice (white rice with the outer layers removed).

People with hyperthyroidism, chronic (long-term) diarrhoea, alcoholism and severe liver disease, and pregnant and breastfeeding women may also develop a secondary vitamin B1 deficiency. It can also occur following gastric bypass surgery.

Early symptoms of vitamin B1 deficiency include tiredness, irritability, poor memory, sleep problems, weight loss and stomach pain. Symptoms of severe deficiency in vitamin B1, known as beri beri, include confusion, pain and weakness in the legs and arms, nerve damage, oedema (fluid under the skin) and irregular heart rate. It can lead to heart failure and death.

Babies breast fed by mothers with vitamin B1 deficiency can develop infant beri beri, and may suffer sudden heart failure.

Beri beri is treated with an improved diet or with vitamin B1 supplements, and patients may improve within an hour of receiving the first dose.

Vitamin B3 Deficiency and Pellagra

Primary vitamin B3 deficiency is caused by a lack of vitamin B3 in the diet, and it is often seen in countries where the main diet is maize, which includes vitamin B3, but this is in a form that cannot be absorbed. Traditionally, people treated maize grains with lime or other alkalis and this released the vitamin – however, as use of maize spread around the world, the treatment died out and so deficiencies increased.

The body can convert tryptophan, an amino acid found in high protein foods such as soybeans, meat, poultry, fish, and eggs, into vitamin B3, and so a lack of tryptophan can also cause vitamin B3 deficiency.

People with carcinoid tumours, Hartnup disease, chronic diarrhoea, cirrhosis, or alcoholism may also develop a lack of vitamin B3 as a side effect of their disease (secondary vitamin B3 deficiency).

A mild deficiency in vitamin B3 causes a slow down in the body’s metabolism, making people feel the cold more. Severe deficiency causes pellagra. The name ‘pellagra’ comes from Italian for ‘rough skin’. Its symptoms are often described as ‘the four Ds’ – diarrhoea, dermatitis (skin inflammation), dementia, and death. Other symptoms include a sensitivity to sunlight, aggression, hair loss, oedema, swelling and reddening of the tongue, trouble sleeping, weakness, lack of coordination and heart disease.

People with untreated pellagra can die within four or five years. Vitamin B3 deficiency and pellagra are treated with a balanced diet, and with a vitamin B3 supplement.