What is beriberi
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Understanding Beriberi: Causes, Symptoms, and Populations at Risk
What is Beriberi?
Beriberi is a disease caused by a deficiency of thiamine (vitamin B1), which is essential for glucose metabolism and proper functioning of the nervous and cardiovascular systems 12. The term "beriberi" originates from the Sinhalese phrase meaning "I cannot, I cannot," reflecting the profound weakness experienced by those affected .
Types of Beriberi: Wet and Dry
Beriberi manifests in two primary forms: wet beriberi and dry beriberi.
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Wet Beriberi: This form primarily affects the cardiovascular system, leading to symptoms such as high-output heart failure and cardiogenic shock . It is characterized by generalized edema and serous effusions, often resulting in cardiac hypertrophy and potentially sudden death .
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Dry Beriberi: This form impacts the nervous system, causing peripheral polyneuropathy with motor and sensory loss. Symptoms include intense neuropathic pain and axonal injury, which may initially resemble demyelinating diseases like Guillain-Barre syndrome 12.
Causes and Risk Factors
The primary cause of beriberi is a thiamine deficiency, which can result from various dietary and lifestyle factors:
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Dietary Deficiency: Beriberi is often linked to diets high in polished rice or white wheat flour, which lack thiamine 45. Historically, it was observed in populations consuming overmilled rice, as the thiamine-rich pericarp and aleurone layers are removed during milling .
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Gastric Surgery: Post-gastric surgery patients, such as those who have undergone sleeve gastrectomy or bariatric surgery, are at risk due to impaired nutrient absorption 16. Thiamine deficiency in these patients can lead to beriberi, even years after the surgery .
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Alcohol Consumption: Alcohol interferes with thiamine absorption and utilization, making chronic alcoholics particularly susceptible to beriberi .
Populations at Risk
Beriberi disproportionately affects vulnerable populations, including:
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Indigenous Communities: In Brazil, a significant number of beriberi cases have been reported among indigenous people, particularly in the Legal Amazon region 37. Factors such as food insecurity, traditional diets, and high physical exertion contribute to the prevalence in these communities 79.
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Low-Income Populations: Beriberi is often associated with poverty and food insecurity, affecting those with limited access to a balanced diet 37.
Diagnosis and Treatment
Diagnosis of beriberi involves a thorough medical history to identify potential dietary deficiencies and risk factors such as alcohol consumption and recent gastric surgery . Clinical symptoms and response to thiamine supplementation are critical for diagnosis .
Treatment involves prompt administration of thiamine supplements, which can significantly reduce morbidity and mortality if given early . Long-term management includes dietary education and regular nutritional assessments to prevent recurrence .
Conclusion
Beriberi remains a significant health issue, particularly among populations with dietary deficiencies and those undergoing gastric surgeries. Understanding the causes, symptoms, and at-risk populations is crucial for early diagnosis and effective treatment. Addressing food insecurity and providing nutritional education are essential steps in preventing this potentially debilitating disease.
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