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To the Editor: In his consideration of an elderly man with memory loss and neuropathy, Dr Brust¹ discussed Wernicke-Korsakoff syndrome, sometimes known as cerebral beriberi. Brust mentioned the patient's alcohol intake as a possible precipitant. I would like to add 2 points.

First, Brust noted the relatively high prevalence of Wernicke-Korsakoff syndrome in Australia. Flour and bread were not fortified with thiamine in Australia as early as in other countries. An expert committee in Australia had studied the question and concluded that the average Australian diet contained enough thiamine, although it recognized that Australian alcoholics were not consuming enough thiamine.²

This principled approach had the unintended effect of providing nutritionists and clinicians with a geographic natural experiment. Autopsies performed in the 1980s showed that the prevalence of Wernicke-Korsakoff syndrome was much higher in Australia than in other countries that enriched their bread. Policy was reversed, and Australian millers added thiamine . . . [Full Text of this Article]

Frances R. Frankenburg, MD
frances.frankenburg@med.va.gov
Edith Nourse Rogers Memorial Veterans Hospital
Bedford, Massachusetts

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