Just a Spoonful of Thiamin?

  • Two neurological disorders linked through thiamin deficiency
  • One disorder can be treated with thiamin supplements, the other may be incurable
  • Heavy drinkers, anorexics and senior citizens considered at risk
  • Up to 10 percent of alcoholics in the U.S. may be affected
  • Australian cases decreasing, but thiamin may yet be added to beer

Something as simple as thiamin (vitamin B1) may help, or hinder, your brain’s capacity to function and perhaps even survive. Alcoholics, anorexics and senior citizens may be especially vulnerable, according to recent studies of two neurological disorders called Wernicke’s encephalopathy (WE) and Korsakoff’s Syndrome (KS). The two studies, published in the October issue of Alcoholism: Clinical & Experimental Research, jointly found that mammillary bodies in the brain may shrink as cognition and memory decrease.

"These findings are significant because they point toward the importance of nutritional factors in the condition of the brain," said Edith V. Sullivan, Associate Professor of Psychiatry, Stanford University School of Medicine and lead author of one of the studies. "Nutrition, ultimately, affects the very function or cognitive well-being of the brain." Sullivan based her study, funded by the National Institute on Alcohol Abuse and Alcoholism, on in vivo or living patients.

WE is a potentially fatal disorder caused by thiamin deficiency. WE usually occurs in people who have been drinking heavily and not eating, but can also occur after persistent vomiting or during hunger strikes. Recent studies, said Sullivan, have shown that young women suffering from anorexia nervosa may also develop WE due to severe nutritional deficiencies. Of increasing concern is the potentially large number of senior citizens who may be apathetic about the quality of their diet, may not be eating enough, or may forget to eat altogether. Yet clearly heavy drinkers are those known to be most affected by WE.

"Brain damage as a result of alcohol consumption is probably the second most common cause of dementia in the United States, behind Alzheimer’s Disease," said Dr. Peter R. Martin of the Vanderbilt University School of Medicine. Heavy drinkers often eat improperly and, furthermore, alcohol impedes the digestive tract’s normal absorption of those few nutrients that may be consumed. Nerve, muscle and brain tissue are extremely sensitive to low levels of vitamins, nutrients and minerals and can begin to deteriorate when deprived. Body stores of thiamin can be depleted within about three weeks.

WE is characterized by double vision, mental confusion, muscle weakness and unsteady gait. Unlike other disease states caused by alcohol, WE may reverse through rapid treatment with thiamin. If left untreated, however, the person can go into a coma and die. In some cases, even if treated, they can develop permanent memory damage in the form of KS.

KS is often associated with a previous episode of WE but is distinguished by amnesia. KS is often recognized when the confusion associated with WE clears following thiamin treatment. Although KS may sometimes respond to thiamin treatment, it is often permanent.

Although KS appears to occur in patients who suffer repeatedly from acute WE, researchers disagree about the precise association between WE and KS. Sullivan called the exact relationship "arguable" whereas Martin said, "it’s pretty clear that they’re related, WE is the acute or severe phase and KS is the chronic or perpetual phase." Researchers do agree, however, that the nutritional deficiencies caused by heavy drinking can lead to WE and, if not treated, eventually KS.

Exact numbers of those afflicted are difficult to find but Martin speculated that at least 10 percent of alcoholics have some degree of the two syndromes. Even though most alcoholics do not have the characteristics of an "extreme stage of brain damage" such as Wernicke’s or Korsakoff’s, "70 percent of alcoholics have some sort of brain damage," he said. "At one point I calculated that there were about 10 million people in the U.S. who may have some sign of brain damage related to alcohol," he said.

In Australia, the two disorders are often referred to jointly as Wernicke-Korsakoff syndrome (WKS), according to Clive Harper, Professor of Neuropathology at the University of Sydney and Royal Prince Alfred Hospital and lead author of the second study published in Alcoholism: Clinical & Experimental Research. During the 1980s, Australia had the ignoble distinction of having the highest recorded rates of WE in the world, mostly among the alcoholic population, as well as large numbers of people needing long-term care because of KS. Harper estimated the former at 500 cases per year, the latter at 2,000 per year.

The problem was considered so acute that in 1991, the Australian government mandated that bread flour be enriched with thiamin. This same requirement has been mandatory for a number of years in the United Kingdom, Canada and Denmark; in the U.S., most bread flour is enriched but enrichment is not mandatory. In other countries such as Japan, rice is enriched with thiamin. Since the 1991 enrichment of bread flour in Australia, WKS rates have significantly decreased but remain higher than those in most other Western countries - enough to prompt discussion of thiamin supplementation of alcoholic beverages, primarily beer (the preferred beverage of many WE patients).

Harper said that "WE diagnosis is probably missed about 80 percent of the time worldwide." Harper based his comments on thousands of brain autopsies, having found that mammillary bodies are "abnormal" between 99 and 100 percent of the time in WKS cases. "About one in every hundred people who have a Coroner’s autopsy are found to have WE, even though it is very easy to treat, because the diagnosis can easily be missed." People suffering from WE or KS or WKS, whatever name you prefer, he said, clearly make up "a big hidden group throughout the world that needs further study."

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Sheedy, D., Lara, A., Garrick, T., Harper, C. (1999, October). Size of mamillary bodies in health and disease: Useful measurements in neuroradiological diagnosis of Wernicke’s encephalopathy. Alcoholism: Clinical and Experimental Research, 23(12), 1624.

Sullivan, E.V., Lane, B., Deshmukh, A., Rosenbloom, M.J., Desmond, J.E., Lim, K.O., Pfefferbaum, A. (1999, October). In vivo mammillary body volume deficits in amnesic and nonamnesic alcoholics. Alcoholism: Clinical and Experimental Research, 23(12), 1629.