Beriberi, White Rice, and Vitamin B: A Disease, a Cause, and a Cure (review)

Kenneth J. Carpenter. Beriberi, White Rice, and Vitamin B: A Disease, a Cause, and a Cure. Berkeley and Los Angeles: University of California Press, 2000. xiv + 282 pp. Ill. $40.00; £24.95.

With breakfast cereals, juices, and candy as well as wheat flour now fortified with vitamins, and with half the U.S. adult population taking vitamin supplements, it is difficult to remember that vitamin-deficiency diseases were once widely prevalent. Beriberi, for example, caused by thiamine deficiency, ranked second only to smallpox as a cause of death in Japan in the late 1870s, affected more than ninety thousand Japanese soldiers in Manchuria in 1904-5, and remained endemic until the end of World War II. How its cause was discovered constitutes one of the great myths of nutritional science. As set forth in virtually all nutrition textbooks, people who ate white rice as their principal source of calories were healthy until the 1870s, when steel milling machines were introduced that more efficiently removed the thiamine-containing bran and germ layers. The myth has a scientist-hero: the Dutch physician Christiaan Eijkman, who discovered in Indonesia that chickens fed white rice developed the polyneuritis of beriberi whereas those fed unmilled rice did not.

The reality, as Kenneth Carpenter convincingly explains, is far more complicated. Beriberi is an ancient disease that predates milling machines by millennia. Other physicians recognized the dietary origins of beriberi prior to Eijkman's experiments, and another fifty years of continuous investigation elapsed before scientists agreed that beriberi was due to thiamine deficiency rather than an infection. No wonder: the thiamine content of rice varies with the extent of milling, length of cooking, water absorption, and its bioavailability--and beriberi appeared among diverse populations, not all of whom consumed rice. Today, scientists still debate how best to prevent such conditions.

Carpenter begins this story with beriberi in Japan in the late 1880s; moves to Portuguese accounts in Indonesia of the 1500s; tells Eijkman's tale; describes the disease in Malaysia, Sri Lanka, and the Philippines; and then goes to places where beriberi was not associated with milled rice. One problem with the geographical focus of this history is that the chronology of events is sometimes difficult to follow. Other chapters cover issues related to the milling of rice, the thiamine content of foods, physiological requirements for thiamine, and public health implications. For readers with a more scientific bent, appendices provide descriptions of the organic chemistry and biochemistry of thiamine. In the years since his retirement from the Department of Nutritional Sciences at Berkeley, Dr. Carpenter has established a lively second career as a historian of nutrients. This book is his third. Like the previous two (The History of Scurvy and Vitamin C, 1986; Protein and Energy: A Study of Changing Ideas in Nutrition, 1994), this one was written the old-fashioned way, by hand on paper. Nevertheless, Carpenter brings a thoroughly up-to-date sensibility to his analysis of scientific and descriptive sources that take thirty-three pages to list.

Moreover, Carpenter is a generous historian, kind to even the most pigheaded of investigators who claimed beriberi to be an infectious disease. He grinds no axes, even in the one area that still remains contentious--the remedy. The milling of rice removes many other nutrients as well as thiamine; beriberi, therefore, is the visible manifestation of deficiency of the most limiting vitamin in nutritionally inadequate diets. The enrichment of flour replaces thiamine and a few other nutrients, but not all. Should policymakers encourage people to take supplements, further enrich flour, or instead focus on public health measures to improve overall diets? In the long run, would it not be better to promote crop diversification, improved economic conditions, and more education as more effective approaches to eliminating dietary deficiencies? Carpenter discusses these policy options but takes no firm position. He...