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Brain fog
Can't walk without hold onto something
Leg pain
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Unusual behavior
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Wernicke encephalopathy (WE) is an acute neurologic condition condition characterized by vision changes, ataxia (loss of coordination and balance), and confusion. It is caused by B1 or thiamine deficiency.
Your doctor may ask these questions to check for this disease:
Wernicke encephalopathy requires intravenous or intramuscular thiamine for treatment.
Reviewed By:
Samantha Nazareth, MD (Gastroenterology)
Board-certified gastroenterologist. Experience managing gastrointestinal conditions (GERD, IBS, ulcerative colitis, Crohn’s, celiac disease, NASH) within healthcare organizations (three ambulatory surgical centers, single-specialty practice, multi-specialty practice and solo practice).
Shohei Harase, MD (Neurology)
Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.
Content updated on Dec 5, 2025
Following the Medical Content Editorial Policy
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Q.
Brain Fog? Why Your Brain Needs Thiamine & Medically Approved Next Steps
A.
Brain fog can be caused by low thiamine (vitamin B1), which the brain needs for energy; even mild shortage can impair focus and memory, and severe deficiency can lead to Wernicke encephalopathy requiring urgent care. There are several factors to consider. Medically approved next steps include improving whole-food intake, limiting alcohol, asking your doctor about targeted labs for thiamine and other causes, watching for red flags like confusion or balance problems, and discussing safe supplementation; see complete details below to guide the right actions for you.
References:
* Lu'o'ng KV, Nguyên LT. The role of thiamine in the development of Alzheimer's disease. *CNS Neurosci Ther*. 2013 Dec;19(12):886-890. doi: 10.1111/cns.12181. PMID: 24119857; PMCID: PMC6493649.
* Zou P, Sun H, Huang D, Mao Y, Li J, Wang D, Wang H, Wang Z, Han Y, Wei Y, Cao Y, Wang Z. Thiamine deficiency-induced brain dysfunction: mechanisms and therapeutic implications. *Neural Regen Res*. 2023 Mar;18(3):575-582. doi: 10.4103/1673-5374.346366. PMID: 36248679; PMCID: PMC9627670.
* Frank RA, De Souza R, Ullman D, Storey E. Thiamine for cognitive impairment in people with and without alcohol misuse. *Cochrane Database Syst Rev*. 2020 Sep 21;9(9):CD004013. doi: 10.1002/14651858.CD004013.pub4. PMID: 32959885; PMCID: PMC7506690.
* Gold M, Johnson C, Shoemaker T, Smith D, Sayre R, Song D, Zhang H, O'Neill J, Han J. Thiamine deficiency and the brain: A new perspective. *J Neurol Sci*. 2020 Jun 15;413:116852. doi: 10.1016/j.jns.2020.116852. Epub 2020 Mar 27. PMID: 32247169.
* Chandrakumar LP, Ayyappadas P, George B, Menon RP, Radhakrishnan K, Cherian A, Thulaseedharan JV, Jayalakshmi S. A Prospective Observational Study on the Efficacy of Intravenous Thiamine in Treating Cognitive Impairment in Patients with Wernicke Encephalopathy. *Neurol India*. 2022 Sep-Oct;70(5):1848-1853. doi: 10.4103/0028-3886.355152. PMID: 36203588.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Intern Med J. 2014 Sep;44(9):911-5. doi: 10.1111/imj.12522. PMID: 25201422.
https://onlinelibrary.wiley.com/doi/10.1111/imj.12522Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL. Wernicke Encephalopathy-Clinical Pearls. Mayo Clin Proc. 2019 Jun;94(6):1065-1072. doi: 10.1016/j.mayocp.2019.02.018. PMID: 31171116.
https://www.mayoclinicproceedings.org/article/S0025-6196(19)30255-1/fulltextFujikawa T, Sogabe Y. Wernicke encephalopathy. CMAJ. 2020 Feb 10;192(6):E143. doi: 10.1503/cmaj.190998. PMID: 32041699; PMCID: PMC7012630.
https://www.cmaj.ca/content/192/6/E143Ota Y, Capizzano AA, Moritani T, Naganawa S, Kurokawa R, Srinivasan A. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol. 2020 Sep;38(9):809-820. doi: 10.1007/s11604-020-00989-3. Epub 2020 May 10. PMID: 32390125.
https://link.springer.com/article/10.1007/s11604-020-00989-3