Wernicke-Korsakoff Syndrome, or wet brain as it is commonly called, is caused by a lack of thiamine, also known as vitamin B1, which the brain needs to function.
It is often a consequence of drinking extremely large quantities of alcohol over a long period of time, as some people who drink to great excess live on a “liquid diet” and stop eating.
Alcohol also interferes with absorption of thiamine and the liver’s capacity to store it. Wernicke-Korsakoff Syndrome rarely occurs outside of conditions of extreme alcohol consumption, starvation, or HIV.
What is Wet Brain?
“Wet brain” is actually a combination of two conditions: Wernicke’s encephalitis, and Korsakoff Syndrome. Wernicke’s encephalitis is rapid onset and is irreversible unless large doses of thiamine, usually via IV, are administered with in a very short period of time, such as three days.
Symptoms include opthalmoparesis (weakness or paralysis of the eye muscles), ataxia (lack of coordination and muscle control, leading to irregular gait, or plainly put, stumbling around) and confusion and memory loss.
Korsakoff’s Psychosis often develops as the symptoms of Wernicke’s encephalitis resolve, and is a permanent condition resulting in inability to form new memories, severe loss of memory, and hallucinations. People with Korsakoff’s Psychosis often make up stories to try to make up for gaps in their memories, a phenomenon called “confabulation.” They may believe these stories are true, as they are unable to remember what has actually occurred. People with Wernicke-Korsakoff Syndrome are usually unable to function normally, and most require permanent institutionalization, causing tremendous costs to the healthcare system and irrevocable damage to quality of life.
Wernicke-Korsakoff Syndrome is not caused by alcohol itself, rather it is caused by thiamine deficiency as a result of malnutrition and lack of thiamine absorption. There is a simple solution to this problem that could be easily implemented, saving countless dollars in healthcare spending and thousands of years of quality life for those who have severe alcohol problems. What’s this simple solution?
Put thiamine into alcoholic beverages.
Fortification With Thiamine
The idea of fortifying alcoholic beverages with thiamine has been around for a long time. Synthetic thiamine was first developed in 1936 (ironically right around the time Alcoholics Anonymous was getting its start) and the alcoholic beverage industry began to fortify their products with thiamine. According to a 1979 New York Times article calling for the fortification of liquor with thiamine, Seagrams and Sons, the California Wine Institute, and Anheuser Busch all found thiamine supplements to be stable in their products, without affecting taste. Drug companies also started to develop thiamine fortified wines.
According to a 1979 New York Times article calling for the fortification of liquor with thiamine, Seagrams and Sons, the California Wine Institute, and Anheuser Busch all found thiamine supplements to be stable in their products, without affecting taste. Drug companies also started to develop thiamine fortified wines.-Kenneth Anderson
Then the federal government stopped the fortification of alcoholic beverages by issuing a ruling that vitamin content could not be listed on their labels. Since by law food additives have to be listed on labels, this effectively outlawed putting thiamine into alcoholic drinks. The American Medical Association jumped on board, saying that thiamine wines were “unacceptable.”
This is a classic fight between those who believe in abstinence-only, and would prefer that “alcoholics” suffer and die rather than implement public health measures to minimize harm, and harm reduction, which attempts to protect the health of those who use substances and minimize the negative consequences of problematic substance use. Opponents of fortification argue that putting vitamins into alcoholic beverages would encourage their consumption, and that manufacturers would advertise beer and liquor as health foods. Proponents of harm reduction point out that some people are going to drink to great excess no matter what (they did, even during prohibition!) and that the cost in healthcare spending and human life is so great that to deprive people of a simple and cheap intervention that could save quality of life years is nothing short of being an accomplice to murder.
By 1979 estimates, each dollar invested in thiamine fortification of alcoholic beverages would save $7 in nursing home care for those with Wernicke-Korsakoff’s. Imagine what this savings could equal with today’s healthcare costs.
Letting Politics Trump Science
The United States is not the only nation to engage in debate around thiamine in liquor. In Australia, which has very high rates of Wernicke-Korsakoff Syndrome and high rates of alcohol consumption overall, health authorities have had similar arguments about the effects on public perception of alcohol use to those in the US. After much debate, Australia finally began to fortify bread with thiamine.
Even this change did not come about without controversy: in the 1970’s, a graduate student working in a tiny town of 3,500 people, 25% of whom were Aboriginal (meaning they were native to Australia before the British colonized the continent), found that more than 30% of the Aboriginal population of the town had classic signs of severe vitamin deficiency. As their diet consisted mostly of white bread with honey and sweetened tea, a result of years of government rationing where the only foods given to Aboriginal people were flour, sugar and tea, the graduate student theorized that if he could fortify the bread with vitamins, he could reduce or eliminate vitamin-deficiency related diseases.
He collaborated with the local baker to do so, in compliance with legal regulations on food fortification and with the approval of the local residents. However, as soon as the national press got wind of this, an article came out in the National Times called “The Guinea-Pigs of Bourke: The Secret Bread Experiment.” While many doctors agreed with the graduate student’s intervention, he was vilified in the national press and the baker, unable to handle the stress, refused to continue fortifying the bread. Sure enough, while blood levels of essential vitamins in Aboriginal people had become safe and normal during the fortification era, they returned to clinically low levels once fortification ended, and diseases returned.
Eventually Australia, as well as the US, began to fortify bread with thiamine and other vitamins. The controversy shows us how politics often trumps science and true concern for the public’s health. Especially for those who are the most vulnerable and stigmatized, such as those who use alcohol and other drugs in dangerous amounts, measures that would help preserve health and prevent needless deaths are too often rejected by later day Puritans who seem to view these diseases as punishment for the “sin” of consuming substances.
Ending Wernicke-Korsakoff Syndrome in Alcohol Users
While the US now fortifies bread, this does little to help those who drink but do not eat, a common pattern for people who drink extreme amounts of liquor daily over a long period of time. Fortification of all alcoholic beverages with thiamine could put an end to Wernicke-Korsakoff Syndrome in alcohol users, yet our government continues to keep fortification illegal. Apparently, they would prefer that severe alcohol users suffer and die rather than live long enough to get a chance at changing their drinking.
“I went to visit Pete and it was so depressing,” said Al, a member of HAMS whose personal choice has been abstinence for alcohol for the last fifteen years, but who supports harm reduction wholeheartedly. “He couldn’t hold a conversation. He didn’t remember the nurse checking on him ten minutes before. It was like he barely knew who I was.”
Al’s friend for over thirty years is now in a nursing home, at the age of 55, showing signs of dementia that would be more normal in a 90-year-old Alzheimer’s patient. Al supported Pete through numerous attempts to change his drinking, but nothing worked. Thiamine in the whiskey and beer Pete consumed on a daily basis could have saved his brain…and his life.
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18;185(6):343-4. Erratum in: Med J Aust. 2006 Nov 6;185(9):528.
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