2010年7月23日 星期五

腳氣病 Beriberi

Beriberi, caused by Vitamin B1 or thiamine deficiency, has not been a major illness in China or Taiwan. Traditional Chinese medicine manages it efficaciously by using dietary barley [without the knowledge that it is loaded with thiamine]. In contrast, beriberi was widespread in Japan in the Meiji Era when the polished rice found its way into the Japanese diet. Polished rice is rice with the outer husks removed - together with the thiamine contained within, unfortunately. It is far more tasty and at the same time more pleasing to the eye than the unpolished brown rice, and very quickly, it became the main staple food of the Japanese.

However, unlike the Chinese who consumed rice together with other relatively sumptuous dishes, the Japanese tended to eat rice by itself, accompanied if ever, by a small amount of pickled vegetables and some fish. The meals of the Japanese enlisted men consisted of almost all polished rice - as it turned out that this was the reason why beriberi broke out in great numbers.

It was unknown in the beginning that thiamine-deficiency was the causative factor. The medical corps of the IJA and the IJN were split on the management of beriberi. A British-educated IJN medical officer 高木兼寛Takaghi Kanehiro found in 1883 that if western-style rations with bread and meat were provided to the crew on a training mission, none developed beriberi; whereas on the same 10-month journey one year earlier, with only polished rice on board, 169 of the 378 crewmen came down with the illness. Western meals were therefore adopted as a standard fare by the IJN. The IJA medical corps, on the other hand, adhered to its German training, believing that beriberi was an infectious disease caused by some unknown bacteria. For years and in both the Sino-Japanese (1894-5) and the Russo-Japanese (1904-5) wars, casualties from beriberi mounted until 1905, when barley, based on Chinese medicine, was introduced into the military diet that finally brought the disease under control. The document below was the official order No 266 dated March 27, Meiji Year 38 (1905), for the IJA to add 30% barley [often unwelcome to the servicemen] to its rice rations:
In 1910, Japanese chemist 鈴木梅太郎Suzuki Umetaro finally identified Vitamin B1 and linked its deficiency to beriberi; although the Nobel prize for its discovery went to Dutchman Christiaan Eijkman in 1929. [Suzuki waz robbed.]

The search for a more palatable substitute than barley had led to the development of dried yeast tablets. And one of the most famous brands was/is Wakamoto [see insert]. Next time when you travel by Taipei Metro, take a few moments and examine the giant Wakamoto posters on display in many of the stations. You'll know that there is a long history behind this nutritional supplement that contains a secret ingredient, Vitamin B1 (thiamine). Wakamoto yeast tablets in fact went on sale in 1929 and have remained on the market ever since.

Beriberi also had a close yet hidden association with Taiwan. The Sino-Japanese war ended with China ceding Taiwan to Japan. And in June, 1895, the IJA occupation force invaded Taiwan and fought against its residents. It was often unquestioningly cited that the Japanese casualty totaled 4,806, and of that number, 4,642 died from diseases principally beriberi plus malaria and cholera. We now know that some would have already become ill from beriberi (and cholera) prior to arriving in Taiwan and some were actually combat deaths, and yet the loss was conveniently blamed on the putatively substandard and unsanitary living conditions in Taiwan. Which were not all that different from the rural areas in Japan at that time.

As a side point, the Taiwanese had lived and thrived on this beautiful island Formosa since at least 1662, immune to the many deadly diseases that seemed to strike only the hapless foreign invaders, first the French (1884) and then the Japanese (1895). Tropical medicine has been the expertise of the traditional physicians of Taiwan (and the later addition of Western medicine simply reinforces it). The prevention of malaria and the plaque, and the treatment of cholera and beriberi were in fact all quite well-practiced. But then, Taiwanese doctors were most likely not too eager to help the enemies and the latter too arrogant/fearful to seek any help anyway.

During the Pacific War, beriberi re-surfaced among the Japanese servicemen. As any reasonable consumers of rice, the soldiers also rejected barley in their white rice and the military-issued Wakamoto tablets were equally distasteful.
[Above: a 1940 poster advertising Wakamoto tablets.]

In the 1950s, the then enterprising 台糖公司Taiwan Sugar Corp developed sugar-coated yeast tablets, known to that generation and beyond as 健素糖. They have been wildly popular until killed in 2006 by media reports that the yeast was of questionable quality fit only for pigs. [This time, the Taiwanese kids waz robbed.] A resurrection is presumably in the offing. It still is. In the meantime, Wakamoto dominates, after 81 years.

8 則留言:

  1. Fascinating - thank you for writing that up.

  2. My pleasure. I hope Taiwan Sugar Corp wises up and gives us back the sugar-coated yeast tablets soon.

  3. "During the Pacific War, beriberi re-surfaced among the Japanese servicemen." The were many documented cases among POWs in Taiwan. It seems it led to a horrible swelling of the balls, and resulted from (I am not a doctor though), lack of Vitamin B. Would not brown rice or whole wheat taken care of this?

  4. Not just in Taiwan, beriberi also hit POWs in mainland Japan. The swelling (edema) can also be from a lack of protein made worse by thiamine deficiency.

    Brown rice and whole wheat certainly can take care of it. Potatoes and yams also work although these and brown rice are generally regarded as food for the poor. And whole wheat is found mostly in northern China, people from outside this area do not usually touch the stuff. The deeply ingrained culture is that the white rice reigns supreme. That is why beriberi was unavoidable if the main course of each meal was just polished rice. In any case, polished rice is now enriched with vitamins.

  5. On a complete aside, I've read that white rice might be the main culprit in the disturbingly high diabetes rate here in Taiwan (twice the world average).

    Researchers are linking coffee consumption to lower rates. Taiwan has gone coffee mad in the last ten years. Throw a stick up and it'll land on or near a Starbucks in Taipei (not that I want to be pitching for this multinational or anything like that). Nevertheless, this trend could bode well in the health condition of our nation. Let's hope.

  6. Type 2 diabetes (and an assortment of other problems) is caused by excess body weight. As a result, the level of insulin no longer meets the needs. The white rice may raise the blood sugar level, after all, rice=starch=long chain polysaccharides=glucose, but it is NOT a causative factor per se.

    I have also noticed the mushrooming of Starbucks. Personally, I prefer Dunkin' Donuts coffee. Unfortunately, the lone one near Danshui Metro Station is now gone, taken over by Mister Coffee, a Japanese chain. If coffee consumption lowers the diabetes rate, so much the better. Let's all drink away.

  7. I like Dunkin's coffee too.

    I normally buy from a local cafe near my office. It tastes almost as good as Starbucks, but comes for half the price. Plus I'd rather put my money into the immediate economy. The server, who is also the owner, can tell from my facial expression whether I want a hot Americano, hold the cream and sugar, or an iced cappuccino, with milk and half the sugar.

    There is a Dunkin' now at the Danshui MRT Station, across from Mr. Donut. I think the latter was once owned by Dunkin', but grabbed it's own identity in Japan in the nineties.

  8. Is it Mr Donut? I went by that area twice a day for 10 days recently. Guess I need another cup of coffee, now.

    There is supposedly another Dunkin' near Gu-ting station which I have not been to yet. In a pinch, I settle for a local brew near where I stay, usually piping hot in a cup with the lid scotch-taped onto the cup on two sides, a unique Taiwan invention. All for NT$20.