Prevention

Southeast and East Asian countries pioneered in developing strategies for the prevention of beriberi. As we have seen, prevention of shipboard beriberi through dietary change was initiated by Japanese and Dutch naval medical officers late in the nineteenth century, long before the recognition of thiamine’s role. The section “Causal Research” also took note of the development, early in the twentieth century, of countrywide preventive programs and policies, begun in Malaya and the Philippines many years before thiamine was isolated, characterized, and synthesized.

These programs stressed changes in rice milling to preserve bran, together with public education about the risks associated with dependence upon a diet based on polished white rice.

After 1936 the pace quickened as production of inexpensive synthetic thiamine made food enrichment possible. By 1941 the first standards for the enrichment of bread were established in the United States, and enrichment requirements soon followed, during World War II. Enrichment of whole-grain rice presented more problems than flour enrichment for bread, but even these difficulties were overcome so that today thiamine enrichment is available in rice-based diets, as well as in those for which bread is a staple.

For people throughout the world who consume many other kinds of processed foods, including corn and macaroni products, thiamine is also commonly available, as it is in many varieties of vitamin preparations. In the United States today, many individuals are consuming vitamins, often including thiamine, far in excess of the recommended dietary allowances, and it is estimated that one-third of individuals 65 years of age and older in this country are taking some kind of nutritional supplement (Rivlin 1988).

Williams concluded his 1961 book, Toward the Conquest of Beriberi, with a chapter on the prospects for eradication of the disease, as advocated by a joint United Nations committee (World Health Organization 1958). This committee, meeting under the sponsorship of the Food and Agriculture Organization and the World Health Organization, recommended six preventive measures that, taken together, could be expected largely to eliminate, if not actually eradicate, beriberi in countries where rice is a staple food:

1.  General improvement of the diet to increase its thiamine content.

2.  Encouragement of the use of undermilled rice.

3.  Encouragement of the use of parboiled rice.

4.  Promotion of methods of preparing and cooking

Rice to preserve its thiamine content to the greatest extent possible.

5.  Enrichment of rice.

6.  Increased use of synthetic thiamine in various

Ways other than rice enrichment.

Each of these measures continues today to have its role in beriberi prevention. It should be noted, however, that the committee was not aware, in the 1950s, of the possible extent of the problem of interference with thiamine activity and availability through the actions of thiaminase and other antithiamine agents. Even now this problem remains largely undefined, although in some countries, certainly in northern Thailand and, probably, in areas of Myanmar (Burma), dietary preferences, especially for fermented raw fish, are considered to be the most important causes of endemic beriberi.

Sporadic and subclinical or marginal thiamine deficiency persists today and will continue to do so. Eradication of this deficiency is not in prospect, but neither is recurrent epidemic beriberi.

Frederick L. Dunn