From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: high carb can lead to beriberi, thiamine deficiency
Date: 13 Dec 2004 18:43:24 -0800
Message-ID: <1102992204.917398.199900@c13g2000cwb.googlegroups.com>

Wet beriberi is rarely associated with high carb intake in the West,
due to the fortification you mentioned. Instead, it's usually seen in
alcoholics. And not the beer-drinkers, either. Too much thiamin in
beer.

I once saw an elderly alcoholic who presented with gross pitting edema
bilaterally to his knees. Said his ankles had been swelling for years
and his legs for a few months. No lung congestion that I could hear or
see on X-ray. On exam his blood pressure was normal and his heart was
hyperdynamic, as were his pulses-- didn't feel like the usual case of
CHF. His albumin was low-normal but not spectacularly low. On
ultrasound he had an excellent EF with no sign of restriction.
Tentitively, after a dietary history (he was a bigtime scotch drinker
who lived alone and ate very badly) I considered that I might be
looking at my first case of wet beriberi. And sure enough, after 2
weeks of B-vitamin supplementation, his edema went away and was never
seen again. I never gave him a diuretic at all.

SBH