The long-term effects of alcohol abuse include mental and physical health problems, neuropsychiatric disorders, and early Wernicke’s encephalopathy (WE). It is caused by thiamine (vitamin B-1) deficiency, but is commonly caused by alcoholic malnutrition. It causes confusion, unbalanced walking (ataxia), and eye movement problems (such as jerky eye movements or paralysis of eye movements). Untreated WE can become Korsakoff’s Syndrome (KS), with permanent memory loss and imbalance.
Autopsy studies show that WE is underdiagnosed, with resultant increased risk of KS since some of those with undiagnosed WE don’t get treated. Important to the diagnosis of WE are the following: (1) history of dietary deficiency, (2) eye movement abnormalities, (3) balance problems with walking, and (4) disturbed mental state and memory problems. The present research was done to see if these guidelines can be used in practice to find groups of patients at risk for WE.
The project studied 56 alcoholics and 38 non-alcoholics (men and women). Patients were interviewed about their lifetime alcohol and dietary histories. Patient’s eye movements were tested and they were tested for instability walking and for cognitive impairment. People with just one of these signs were considered to be at risk for WE, and those with two to four of these positive signs were said to “have signs of WE”. Of the alcoholics studied, 57% were at risk for WE, and 16% had physical signs of WE. Of the alcoholics, 52% had dietary deficiency, and 36% had an unsteady pattern of walking. People with dietary deficiencies tended to be younger and included more men than women. Some alcoholics were no different from non-alcoholic controls on neuropsychological testing.
Thiamine blood levels may not be a good way to evaluate thiamine status. About 80% of thiamine is in the form of TDP (thiamine diphosphate), which is active in glucose metabolism. People studied had TDP blood levels, and results were correlated to the physical exams. In this study, TDP levels did not significantly correlate with many factors tested. About half of the alcoholics had dietary deficiency and had lower TDP levels than those without a history of dietary deficiency. The results of TDP levels at the time of the testing might have been completely different from when the person was actively drinking and initiating the neuropsychological deficit.
CONCLUSION: A few simple neuropsychology tests can indicate that an alcoholic is at risk for Wernicke’s encephalopathy or has signs of it already. In that case, they should be treated with thiamine even without clearly abnormal blood thiamine testing. Treatment with thiamine is safe, and thiamine supplementation could be given to all alcoholics. Interestingly, flour for cooking is enriched with thiamine.
NOTE: Thiamine should not be taken with isoniazid (medication for tuberculosis), which thiamine counteracts.
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Rainbow Grocery has the following products: Thiamine (vitamin B-1).
Summary #965. nutrientmedicine