People who fail to eat enough food to meet energy needs risk nutrient deficiencies, including thiamin deficiency. Inadequate thiamin intakes have been reported among malnourished and homeless people. Similarly, people who derive most of their energy from empty-kcalorie items, like alcohol, risk thiamin deficiency. Alcohol contributes energy, but provides few, if any, nutrients and often displaces food. In addition, alcohol enhances thiamin excretion in the urine, doubling the risk of deficiency. Prolonged thiamin deficiency can result in the disease “beriberi,” which was first observed in East Asia when the custom of polishing rice became widespread. Rice provided 80 per cent of the energy intake of the people of that area, and rice hulls (the outer skin of rice) were their principal source of thiamin. When the hulls were removed, beriberi spread like wildfire. Because thiamin participates in nerve processes, paralysis sets in when it is lacking. The symptoms of beriberi include damage to the nervous system as well as to the heart and other muscles.