Wet Brain: Thiamine, Diet and Abstinence
What is Wet Brain?
Wet brain is a term used to describe brain disease that is often associated with heavy alcohol consumption. The medical name for one of these conditions is Wernicke-Korsakoff syndrome (WKS). This syndrome is considered by some to be two separate conditions: Wernicke’s encephalopathy and Korsakoff’s psychosis. Some consider Wernicke-Korsakoff syndrome as one condition which progresses and involves different parts of the brain as it progresses.
Thiamine - Vitamin B1
Both conditions are caused by nutritional deficiencies, especially thiamine, or vitamin B1 deficiency in combination with nerve tissue damage caused by the toxic effects of alcohol. Alcohol affects the way thiamine is absorbed in the body and can also contribute to poor diet; a “liquid diet” consisting of little more than alcohol. So, heavy consumption of alcohol can lead to vitamin B1 deficiency which can lead to wet brain. Proper diet and thiamine supplements can prevent wet brain in heavy alcohol consumers.
Wet brain can also be caused by liver disease, poor diet or vomiting for several days; such as during morning sickness in pregnancy, or with bulimia – an eating disorder that involves “purging” or vomiting to avoid weight gain. It can also develop following gastric bypass surgery, and in elderly persons who live alone and are malnourished. Some research suggests there may also be a genetic component involving an inherited lack of the enzyme, transketolase, that contributes to the development of brain disease.
Whether it is considered a separate condition or the earlier part of a progression, Wernicke’s encephalopathy has a better prognosis than Korsakaff’s psychosis. Wernicke’s encephalopathy affects the cerebellum, the part of the brain that controls coordination and balance, and some forms of learning. Korsakoff’s psychosis involves the part of the brain responsible for memory.
When recognized and treated early, Wernicke’s encephalopathy responds well and very rapidly to thiamine treatment. Korsakoff’s psychosis does not respond as well or as quickly to thiamine treatment, although 20% of people with Korsakoff’s psychosis do recover. The recovery process is slow; taking 6-12 months. Discontinuing use of alcohol is required.
Wernicke’s encephalopathy is a short-lived and severe condition while Korsakoff’s psychosis is long lasting and debilitating. When brain damage is more severe, the course of care shifts from treatment to support and care for the patient and caregivers. People with Korsakoff’s syndrome often require nursing home or custodial care.
Up to 80% of alcoholics have a thiamine deficiency. Some of these will develop serious brain disorders such as WKS. Approximately 80-90% of alcoholics who do develop Wernicke’s encephalopathy will go on to develop Korsakoff’s psychosis. There may be a genetic component that explains why some alcoholics with thiamine deficiency do not develop WKS, but more research needs to be done to understand why some people are more vulnerable than others.
Symptoms of Korsakoff's Psychosis
Korsakoff’s psychosis involves severe memory loss and confabulation – making up stories or talking fluently without facts. A person with Korsakoff’s retains other cognitive functions, to include intellect. Their use of confabulation is an attempt to fill in memory gaps. They are not deliberate or intentional lies: that would require more memory than they have. If you asked the person if you had met before, the person with Korsakoff’s psychosis would make up an elaborate story about how you met that is entirely fantasy. The person is not able to process and store new information, and cannot recall things that happened five minutes after they happen. They will often repeat themselves as a result of not remembering they said something or the response to what they said. Korsakoff’s psychosis often follows DTs (delirium tremens) when a person is withdrawing from alcohol without adequate medical supervision.
Symptoms of Wernicke's Encephalopathy
Wernicke’s encephalopathy is characterized by three symptoms:
- mental confusion – confused, delirious, and apprehensive.
- paralysis of the nerves that move the eyes – nystagmus; difficulty moving eyes to follow a visual stimulus.
- difficulty with muscle coordination, walking (ataxia) and balance; an unsteady gait.
Nystagmus is often the first symptom to appear. It is also the first symptom to disappear in response to treatment. It is not necessary to have all three symptoms of Wernicke’s encephalopathy. The disorder may be present in a person who has only one or two of the symptoms. Autopsies have shown that many cases of thiamine deficiency related encephalopathy were not diagnosed in life because not all of the symptoms were present.
Wernicke-Korsakoff Syndrome (WKS)
Other Alcohol Related Brain Disorders
Cerebral atrophy (brain shrinkage) or alcoholic dementia is related to alcoholism, as well, and is typically seen in people in their 50s and 60s. This condition also responds to thiamine treatment, healthy diet and discontinuation of alcohol use. The damage that has already been done is not reversible, but treatment can stabilize the condition and prevent further progression. There are other alcohol related brain disorders, to include: alcoholic cerebellar degeneration, portosystemic encephalopathy (PSE), central pontine myelinolysis, and Marchiafava-Bignami disease.
The term “wet brain” is an informal term, not a medical term, used to describe a number of irreversible, organic brain diseases related to alcohol that cause mental impairment and physical disabilities, and can result in the need for nursing home care.
A Caregiver's Perspective
- YouTube - Robert's Story
Robert's series of 12 videos that describe in detail his perspective as a devoted husband and caregiver to his wife with Wernicke's Encephalopathy; from the first signs and symptoms to finding treatment and a partial recovery.
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