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BERIBERI. Beriberi is a disease that usually begins with a loss of feeling in the feet and then weakness and pain in walking. In many, but not all, cases the body then becomes swollen and in the most serious cases the heart begins to fail, and the patient becomes breathless and soon dies. The problem stems from an insufficient intake of the vitamin thiamin (or "thiamine") even though we require each day only about 1 milligram, which is equivalent to one 32,000th of an ounce. The word "beriberi" comes from Indonesia and may mean "weak" or "swelling," but there have been many other suggested meanings.

The disease used to be a serious problem in Far Eastern countries where white rice was the staple food and people ate only small quantities of supplementary foods. Husked rice grains provide a reasonable amount of this vitamin, but further processing, or "polishing" to rub off the bran and germ, removes most of the remaining thiamin. Washing the grains and boiling them leaves even less thiamin in the final cooked food. Unfortunately, brown (unpolished) rice goes rancid more quickly under tropical conditions and so has only a short storage life. In traditional peasant communities, where enough paddy (unhusked grain) would be pounded and winnowed each morning for the day ahead, this was not a problem. When inexpensive power machinery for milling and polishing rice was developed, this made the provisioning of the armed forces in particular much more convenient, but in Japan and other Asian countries it was followed by serious outbreaks of beriberi in the army and navy.

Infantile beriberi also has been a major cause of death among breast-fed infants in the Philippines and other communities where mothers are in a state of borderline, subclinical thiamin deficiency. Affected infants typically cease to pass urine and experience difficulty in breathing. Even those near death, however, respond dramatically to a dose of thiamin.

It is technically possible now to mix in with white rice a few vitamin-rich pellets manufactured to resemble rice grains. However, where rice-growing communities each have their own small village mill, it has been found impracticable to control such additions, which slightly increase the millers' costs. As an alternative, communities at risk can be supplied with inexpensive vitamin pills.

In developed countries thiamin deficiency is still a problem among alcoholics, partly because such addicts have highly abnormal diet patterns and partly because they seem to absorb the vitamin less efficiently. They also may show acute heart problems without any early symptoms of traditional beriberi. A small proportion progress to a syndrome with irreversible brain damage that requires indefinite hospitalization.

In many Western countries, millers are required to fortify white wheaten flour with thiamin (along with other micronutrients). Thus, even the population groups, such as alcoholics, who are eating an unbalanced diet are less likely to become deficient. It also has been suggested that alcoholic drinks should be fortified with thiamin. This would not be prohibitively expensive, but authorities have felt that, on balance, it would be undesirable because it would allow them to be marketed as "health drinks" despite the injurious effects associated with or caused by alcohol consumption, that is, automobile accidents, disruption of families, and a wide range of health problems.

See also Dietary Assessment; Dietary Guidelines; Disease: Metabolic Diseases; Rice: Rice as a Food; Rice: The Natural History of Rice; Vitamins: Overview; Wheat.

Kenneth John Carpenter