Fortifying alcoholic beverages with thiamine: Lessons from history and future opportunities

Abstract

Thiamine deficiency remains a significant risk for individuals with chronic alcohol use and is a major contributing factor in the development of Wernicke encephalopathy and Korsakoff syndrome. While clinical guidelines recommend targeted thiamine supplementation in at-risk patients, strategies for prevention at the population level remain limited and underutilized. Among the more unconventional proposals discussed in past decades was the fortification of alcoholic beverages with thiamine. This idea received particular attention in Australia in the 1980s, where high prevalence rates of Wernicke encephalopathy and Korsakoff syndrome led to a broader public health debate. Although fortification was ultimately limited to flour and cereals, the discussion raised important questions about feasibility, effectiveness, and ethical considerations, many of which remain unresolved. This commentary revisits the history of this debate, drawing on empirical studies, review articles, and opinion-based contributions published in scientific journals from the 1940s to the present. Particular attention is given to the counterarguments raised against beverage fortification, including concerns about thiamine absorption, the potential behavioral implications of such a measure, and doubts about its political and regulatory feasibility. These arguments are examined in their historical context, including how they evolved over time, what types of evidence they were based on, and how they were discussed across clinical disciplines and scientific forums. By tracing the development of this largely overlooked policy proposal, this article aims to clarify the central points of contention and encourage a more nuanced understanding of the rationale, limitations, and potential of thiamine fortification in the context of alcohol-related health risks.

Keywords: Fortification; Korsakoff; Thiamine; Wernicke.