Brain disorder caused by a lack of vitamin B-1

African american team of doctors examining patient disease in hospital ward at healthcare clinic. Man and woman specialists with face masks talking to young person about healing treatment.

Terry* walked down the corridors of the campus with her head held high. Though she maintained a straight face, laced with a hint of snobbery, deep inside she was beaming with deep satisfaction.

Terry had spent her entire childhood picked on because she was the big child. She was always three dress sizes ahead of her agemates and she hated it. By age 10, she could only find clothes in the adult section.

Everyone constantly remarked about her appetite. In spite of the fact that she was the best butterfly swimmer in her age category at school, she did not lose weight. While her peers snacked on junk foods, her mum carefully ensured her snack bag had fruit, carrot sticks and whole meal bread.

With age, Terry learnt to ignore the snickers and focused on her books and her beloved swimming. This was until her final year of high school when she developed a gigantic crush on a boy she met at the swimming meets. By this time, she held the title of best female butterfly swimmer in the country and was quite popular in the swimming circles.

However, fame wasn’t enough to attract the boy she fancied and he rudely told Terry that no boy would want to date a whale, even if it was the fastest swimming whale in the world. To say Terry was crushed was an understatement. Terry quit the school swim team and focused on her books. Academics was the one thing she could control, it was a safe bet.

She passed her exams with flying colours but never stepped into a pool again. She vowed to do so the day she would be a size 12. To achieve this, she visited a nutritionist, but after only six weeks, she quit because she wasn’t seeing results fast enough. Thereafter, she tried all manner of online hype diets and fasts without success. She realised that her biggest obstacle was her appetite. She may eat the right food but the quantities remained a problem.

At the end of her rope one day, after stuffing herself with salad and grilled chicken, she sat on the bathroom floor in tears. She sobbed so hard. She vomited her entire lunch and crawled into bed. It occurred to her that if she vomited some of her meals, she wouldn’t have to absorb the calories. Terry’s path to bulimia officially began.

Terry’s secret relationship with bulimia resulted in weight loss that surprised everyone, most especially herself. In four months, Terry was down to size 14 from 20. She was ecstatic but fearful. She was ready for a makeover! She changed her wardrobe, changed her hairstyle and started wearing makeup. She was ready to join university!

Walking on the corridors of the university, watching the shocked faces of her former high schoolmates gave her immense satisfaction. It egged her on to vomit almost all her meals. But this satisfaction did not last long. Terry wondered whether she had made a mistake to join architectural school as she fought subtle loss of concentration and unexplained forgetfulness. She was also constantly tired and her muscles felt sore after minimal exertion.

After her first semester, while at home for the school break, her mom commented that she was walking funny and looked like she had a squint. Terry brushed it off but her mother did not. in the course of the week, Terry deteriorated suddenly, with outright confusion, leading to her family rushing her off to hospital. Several tests later left the doctors confused. They repeatedly asked if Terry drank alcohol, to which the mother emphatically denied. Neither was she pregnant.

Terry was hooked onto coloured infusions in the ward and was mildly sedated to keep her asleep through the recovery. The medical team waited for her to wake up and solve the puzzle. It took about five days before a semblance of the old Terry peeked through. She was aghast when she learnt that her secret habit had led her down this path.

 Terry had suffered Wernicke-Korsakoff Syndrome. This is a brain condition that arises from thiamine (Vitamin B1) deficiency. Thiamine, a vitamin widely found in foods such as beans, lentils, peas, pork, yoghurt and fortified grains and flour, is a vitamin that is difficult to become deficient of. The fact that it is easily available compensates for the fact that the body only stores a measly three-week’s worth. It means it must be consumed daily to prevent deficiency.

 It is therefore a rare deficiency seen commonly in chronic alcoholics who literally forsake food. It is also seen in pregnant women who get severe nausea and vomiting, with inability to retain any food. Even rarer are conditions such as Terry’s, patients who undergo bariatric surgery for obesity and cancer patients.

 The deficiency causes disruption and destruction of specific brain cells, resulting in the symptoms. Hence it is important to initiate thiamine supplementation urgently to reverse the damage. However, for those who have deficiency for long, they will end up with some level of permanent morbidity that may be both physical and psychiatric. 

Terry was lucky. Not everyone is!

Dr Bosire is an obstetrician/gynaecologist

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