Hi All
I had a great day with friends yesterday, i spend my life stressed chasing my tail and yesterday on a nice sunny day I had 4 long beers and lots of chilled fun and it felt great…
Slept only 3 hours and had a bad head which paracetamol struggled to touch and just feel generally very hungover, day written off and feel a bit down, is this due to Hashis or just a bad episode due to stress?
My tolerance of alcohol is greatly reduced since having Hashimotos. I’m such a light-weight and can only manage 2 glasses of wine tops (with food!) I have to alternate wine & water to pace myself, whereas I used to be able to drink more without any ill effects.
I can't even manage a glass of wine these days. So bl**dy annoying!!
I don't suppose lack of sleep helped! 
I would suggest that the fact so many people with thyroid disease end up with poor absorption of nutrients could be the biggest problem in conjunction with alcohol.
In order to metabolise alcohol the body needs sufficient vitamin B1 (aka Thiamine). What happens if there is too little vitamin B1 available and the patient drinks a lot of alcohol over a long period of time?
en.wikipedia.org/wiki/Thiam...
Thiamine deficiency causes quite a few different problems, although I don't know much about any of them :
Beriberi - this comes in two forms, wet and dry. I don't know what the difference is.
Wet Beriberi
en.wikipedia.org/wiki/Thiam...
Dry Beriberi
en.wikipedia.org/wiki/Thiam...
Wernicke's encephalopathy
en.wikipedia.org/wiki/Werni...
Korsakoff Syndrome
en.wikipedia.org/wiki/Korsa...
The above two are collectively known as Wernicke - Korsakoff Syndome because they often occur together.
en.wikipedia.org/wiki/Werni...
Brain Disease/Damage
en.wikipedia.org/wiki/Thiam...
...
Izabella Wentz has discussed Thiamine in some of her blogs.
thyroidpharmacist.com/artic...
...
My interest in thiamine arose from reading an article about Morbid Obesity on Facebook on what used to be a public page. I don't have a Facebook account and can't see it any more. Luckily I copied it.
“Morbid Obesity” by Harold Klawans
“You can’t be either too rich or too thin.” --Dorothy Parker
Morbid Obesity.
The words themselves disgust. The world may love a fat man, but certainly not one who is morbidly obese. I’m not certain when that official diagnostic term came into existence. When I was in medical school, we were taught to call fat patients fat or, if we felt literate, obese. By the time I finished my neurology training, however, internists and surgeons were using the phrase “morbid obesity.”
Patricia Seerey was morbidly obese, and she knew it. She’d been fat for most of her life and by the time she was in high school, she had reached her present state. Her body weight was more than twice her ideal weight. Diets came and diets went; She’d tried them all--rice, grapefruit, Pritkin, Weight Watchers--but nothing helped. She’d been through diet pills and hypnosis. Her girth remained unchanged. There seemed to be only two alternatives--staying obese or undergoing a surgical procedure, such as the removal of part of her stomach (a partial gastric resection). This operation would greatly curtail the amount of food the stomach could hold and thereby limit the amount she could eat. She hated being obese even more than she hated the idea of surgery, so she underwent the surgery. That was two years before she and I crossed paths.
Our first interaction did not involve her directly. It was late on a Tuesday afternoon. I had seen all my patients for the day and was trying to begin work on a paper based on some research we had just completed in my laboratory when my direct line rang. The call was from a lawyer, a good friend of mine. Jeff represented plaintiffs in malpractice suits and had consulted with me on several cases in the past.
Jeff told me all about Pat Seerey. She had been thirty-two years old when disaster struck. She’d always been a heavy girl.
“How heavy?” I asked.
“Very heavy.”
“Morbid Obesity,” I suggested, just to prove that I knew the latest terminology.
“Yes, and she’d tried everything. Nothing worked. So she was referred to a surgeon, Jack Onslow.”
The name meant nothing to me.
According to Jeff, Onslow was a general surgeon who frequently performed operations on patients with morbid obesity.
Pat was 5 feet 6 inches and had weighed 363 pounds. That was morbid enough for Onslow, and he admitted her to the hospital for surgery.
“What procedure?” I asked.
“A gastric resection.”
That meant that he had removed most of Pat’s stomach. As a result she would no longer be able to eat very much, and, consequently, would lose weight. She might never get down as far as pleasingly plump, but she might lose enough to drop the “morbid” and become full figured.
The operation went well; no complications were recorded. She was discharged from the hospital in eight days and went home.
Then the problems began. She started vomiting.
Some vomiting is common after that procedure. The new, smaller stomach is easily overstretched, and food tends to force it’s way back up into the esophagus. To avoid vomiting, the patient has to eat less, which most patients get used to in a short time.
“How often?” I asked.
Every day, I was told. Several times per day. In fact, whenever she ate.
Especially after she ate any protein.
She started to eat less. After all, she was not ineducable.
“Did the vomiting persist?”
“Yes.”
She started to lose weight.
“How much?”
“Ninety pounds.”
“In how long?”
“In less than three months.”
And the vomiting never stopped.
She came back to the hospital once to have a thorough evaluation (a ‘workup’, in medical terminology) to see if anything other than over filling her her small stomach might be causing her vomiting. Neither Onslow nor Lyons, her internist, could find anything else wrong with her.
The vomiting continued, as did the weight loss, and she was soon down to 231 pounds. She’d lost over 130 pounds, and a full figure wasn’t far off. No more muumuus for her.
But then she began to notice a burning sensation in her feet. At first it was very mild, but in a few days, her feet were burning severely from morning to night.
She went to see Onslow, who sent her to Lyons. After all, Onslow was just her surgeon and didn’t know anything about burning feet.
Lyons, in turn, sent her to Frank Baker, a neurologist. Baker thought she might have a mild neuritis--inflammation of the nerves of her legs and feet. He ordered an EMG and explained the test to her. It consisted primarily of sticking needles into her arms and legs. Pat hated needles but agreed to have the EMG the following week.
The next day, her sister noticed that Pat was walking funny, almost as if she was a little tipsy, but Pat never drank alcohol.
The sister called Onslow, who referred her back to Lyons, who told her to call Baker: trouble with walking is a neurologist’s territory.
Baker instructed her to have Pat come in sooner for the EMG.
That night, Pat’s speech started to slur. She also seemed to be confused. She didn’t know where she was or what she was doing. She’d watch television and not be able to tell her sister what she had seen.
Once again, her sister made the rounds on the telephone: Onslow to Lyons to Baker.
Baker said he’d see them the next afternoon in his office.
Pat’s sister didn’t think they could wait that long. She brought Pat to the hospital, and Pat was once again admitted, onto Dr. Onslow’s service.
Onslow saw her at seven-thirty in the morning, just before he was scheduled to perform his first operation of the day, another partial gastric resection on a patient with morbid obesity.
Pat did not recognize him. In fact, she had no idea where she was.
She told him she hadn’t vomited in weeks. And she told him all about the wonderful meal she’d eaten the night before, describing it in detail: steak and potatoes, salad with blue cheese dressing, and chocolate cream pie.
“What did Onslow do?” I asked Jeff.
“He ordered a few routine lab tests, gave her some IV fluids--dextrose and water--and went off to surgery.”
“No vitamins?” I asked, already anticipating the answer. Jeff was a malpractice lawyer, and this was a story of a client of his.
“No.”
“Thiamine?” I suggested weakly, hoping for Pat Seerey’s sake that it had been ordered, for by this time the diagnosis was obvious: Pat Seerery had been starving. She undoubtedly did not look like a victim of starvation, for she was still overweight, but she had been morbidly obese to start with.
She’d been starving for many months, having taken in no food (the meal she’d described to Onslow had been a confabulation)--no calories, no proteins, no fats, no carbohydrates, and no vitamins.
That final element was the culprit. The lack of vitamins--vitamin deficiency--can easily destroy the nervous system, both the peripheral nerves and the brain.
Pat had evidence of neuropathy--tingling of her feet--as well as something going wrong inside her brain--imbalance, confusion, and memory loss. Anyone could tell that.
“Thiamine?” I repeated halfheartedly.
“Now why would he want to do that?” Jeff replied sarcastically.
So much for Jack Onslow, General surgeon. He’d missed the diagnosis and, more important, he’d neglected to treat her at a time when treatment might well have saved her brain.
At one-thirty, Lyons saw her. Pat still didn’t know where she was until Lyons suggested that it was a hotel, and then she remembered having made her reservations. She thought she knew him but said his name was Faber. Red Faber. She also thought it was 1948.
Lyons asked her if she had been vomiting.
Of course not.
Was she eating?
Yes.
Had she had lunch?
Of course.
What?
Soup, Salad, macaroni and cheese, and ice cream. She’d eaten every morsel.
Lyons nodded and then ordered some liver function tests, changed the IV fluid to saline, and requested that Baker see her in consultation.
“Vitamins?” I asked Jeff again.
“No.”
“Thiamine?” I persisted. It was thiamine deficiency that was causing her problem.
“of course not.”
Silly me.
“Was she eating at all?”
“No. According to the nurse’s notes, the sister reported that the patient vomited every time she ate anything. They also noted that she’d refused both breakfast and lunch.”
Baker came by at six o’clock, right after he finished seeing patients in his office.
Pat had no idea who he was.
That wasn’t so strange; she had only seen him once in her life, and for a brief visit.
Did her feet still burn?
No.
She thought she was in a hotel. A man named Red Faber was with her.
Baker asked her if she was still vomiting.
Of course not.
Had she had lunch?
Yes.
What?
Meat loaf, gravy, mashed potatoes, salad, cake, and two rolls with butter.
“Vitamins?” I interrupted.
“No. In his note, Baker remarked that her excellent dietary history made any vitamin deficiency unlikely. Especially since her feet were no longer bothering her.”
“No Thiamine?” I asked once again.
“No thiamine.”
“How did he explain the hotel bit? And Red Faber?”
“Her private life was not any of his concern.”
“And I suppose she ate no dinner.”
“According to the nursing notes, it was sitting there untouched the whole time that Baker was with her. He did order a CAT scan, an EEG, and an EMG.”
The story was becoming increasingly painful. Stupidity is always that way, especially stupidity that harms someone else’s brain.
The question now was how badly Pat’s brain and her life had been damaged.
She’d been admitted on a Thursday. It was late Friday when Baker saw her. None of the tests he had ordered could be done until Monday. No one seemed to mind; none of the tests had been ordered on an emergency basis.
Over the weekend, Pat continued to vomit from time to time and eat practically nothing.
The progression of her neurologic disease was all nicely documented in the nursing notes. On Saturday, Pat stopped talking to the nurse except to say “yes” or “no,” and her answers seemed to have no logical relationship to their questions. Late Sunday night, she stopped talking altogether. By Monday morning, she was in a coma.
Onslow saw her at seven-thirty. He was due in the operating room at eight-thirty.
He had no idea what to do for coma. Coma isn’t a surgical problem. He signed off the case and transferred her to Lyons.
Lyons saw her at nine-thirty. Coma is a neurologic problem, so Lyons paged Baker. Baker was at his office. He suggested that they call the neurosurgeon Glen Moulder.
Moulder was in the hospital and he came right down to see Pat. He had no idea what happened to her, but he knew what tests to order: CAT scan, STAT, angiogram. He administered them himself; they were all normal.
There was nothing that required an operation. No neurosurgery meant no need for a neurosurgeon. He signed off.
Baker arrived and examined Pat.
“He found nystagmus,” I ventured, always the optimist.
“What’s that?” Jeff asked.
He had given me such a complete, documented history that I forgot that he wasn’t a neurology resident but a lawyer.
“Jerky eye movements.”
“Right.”
“So he gave her thiamine.”
“Wrong. He ordered an EEG. He thought that the jerky eye movements were part of a seizure. So he ordeerd a STAT EEG.”
“And it showed no seizure activity.”
“Correct.”
“Just severe, generalized slowing.”
“Right again.”
“What did he do next?”
“A spinal tap.”
“Which was normal.”
“Not quite.”
“It contained a few white cells,” I guessed.
“Yes.”
“So he made a diagnosis of viral encephalitis.”
“That’s what the man did.”
“When did she get her thiamine?”
“About four days later. She was still in a coma, and they moved her from the surgical unit to a medical floor.”
“Who ordered the thiamine?”
“The medical student who was working as an extern.”
“Why?”
“He always gives vitamins to patients who have been on IV’s for a week. He was taught that during the second year of medical school.”
Over the next few days, Pat Seerey woke up, but she never returned to normal. The incidents in the hospital had occurred twenty-three months before Jeff’s phone call.
The significance of that time lag was not lost on me. In Illinois, there is a statute of limitations. A malpractice suit must be filed within twenty-four months of the event.
To prove malpractice, two criteria must be fulfilled;
1. The physician, a hospital, or someone else who is responsible for a patient must have “deviated from the standard of care.” He or she or it’s agents must have done something they shouldn’t have or neglected to do something they should have done. In essence, there must have been an act of negligence.
2. That deviation or act of negligence must have done harm to the patient.
If a doctor screws up right and left and the patient isn’t harmed, then there can be no damages. Such suits rarely come up. Patients who have not been injured or who do not believe they’ve been injured rarely seek out malpractice attorneys. Conversely, if the doctor does nothing wrong but something bad happens to the patient, there is no malpractice, but the patient may well find a lawyer who will file suit.
With respect to the Pat Seerey case, the first question was already answered in my mind. The doctors had erred, but had they done any permanent harm to the once-fat young woman?
Jeff described her present condition. She could not walk without assistance. She could talk but she couldn’t remember much of anything that was new. She remembered almost everything up to about the time of her surgrey. Since then, nothing. She couldn’t even remember if she ate breakfast, much less what she ate.
Damage had been done to her. Had they given her thiamine on time, the damage would have been avoided. And any one of them could have done it; they all had the chance.
Pat had a disease named after two physicians who never met. One was a German neurologist, the other a Russian psychiatrist: Carl Wernicke and Sergei Korsakoff. They were contemporaries. Wernicke lived from 1848 to 1905 and Korsakoff from 1854 to 1900. Wernicke held various chairs in neurology in germany and described a condition we now call “Wernicke’s encephalopathy”--an acute neurologic disorder with three characteristic components:
1. Gait imbalance
2. Altered mentation
3. Jerky eye movements known as nystagmus
Pat had developed all three problems. Her sister had been aware of Pat’s drunken gait and had told the doctor’s about it. Pat’s mental changes should have been obvious to even the most casual observer. Baker had been the only one to look at her eyes and see the jerky eye movements.
Korsakoff worked in Moscow and was the first physician to recognize a peculiar mental disorder in alcoholic patients who also had peripheral neuropathy--injury to the nerves as they go out of the nervous system itself to travel to their destinations in the rest of the body. The neuropathy was due to the vitamin deficiencies caused by the patient’s alcoholism. The commonest sympton of such neuropathies is a feeling of numbness, tingling, or burning in the feet.
Pat’s problem started out with burning feet. Frank Baker realized that she had a peripheral neuropathy, which was why he ordered an EMG. That test is designed to give us information on the function of the nerves as they course through the body.
The mental disorder that Korsakoff observed is now called Korsakoff’s psychosis. Korsakoff described it in these words:
‘At times it appears in the form of sharply delineated weakness of the mental sphere, at times in the form of confusion with characteristic mistakes in orientation for place, time and situation and at times as an almost pure form of acute amnesia where the recent is most severely involved while the remote memory is well preserved...Some have suffered so wide-spread a memory loss that they literally forget everything immediately.’
In a series of carefully written papers, Korsakoff defined the major characteristics of ‘his’ psychosis:
1. Disorientation to time. Pat thought it was 1948.
2. Disorientation to place and situation. She thought she was in a hotel with Red Faber, whoever he was.
3. Amnesia. She couldn’t remember her doctors or that she hadn’t eaten her meals or that she had been vomiting or where she was.
4. An inability to lay down new memories. Had she eaten lunch? She had no memory of the actual event.
5. Confabulation. She made up answers: she couldn’t recall lunch, so she described a meal, and her doctors believed her.
Pat had all the components of Wernicke’s encephalopathy, as well as the manifestations of Korsakoff’s psychosis. While Wernicke and Korsakoff originally described their disorders as separate entities, the research of subsequent neurologists, especially two Americans who worked togethter, Raymond D. Adams and Maurice Victor, has shown that these syndromes are two aspects of the same disease, a disease we now call Wernicke-Korsakoff syndrome. The pathology of both is identical. So is the cause--thiamine deficiency.
Thiamine is a vitamin, and it works the way all vitamins work, by functioning as a coenzyme. All life depends upon enzymes, proteins that carry out a specific biochemical reaction. Glucose, the brain’s major source of energy, must be broken down or metabolized before it can be used. Each step in this metabolic process is carried out by a specific protein or enzyme. The enzyme must be coupled with a vitamin, and if the vitamin is deficient, the enzyme simply doesn’t work.
If thiamine is absent, those enzymes that require thiamine stop functioning.
As a result, glucose metabolism comes to a standstill, and because the brain depends on glucose metabolism, the brain cells are forced to turn to other sources of energy. Brain cells are programmed to keep functioning, and if they cant’ use glucose, all that is left is their own constituents, the fats that make up the cells themselves.
To maintain function, the cells begin to metabolize themselves. They sacrifice structure to maintain function.
Then function fails, and the cells metabolize themselves to death.
Brain damage.
Pat Seerey.
If this happens over a short time, the patient may develop a pure Wernicke’s encephalopathy. If it happens over many months or years, a pure Korsakoff’s psychosis may be seen. Most often, it develops in a few months, and the patient has the mixed features of Wernicke-Korsakoff syndrome.
Pat Seerey started with the burning feet of neuropathy (‘neuritis’) that is due to vitamin deficiency. Then came the imbalance and atlered mentation of Wernicke’s encephalitis, followed closely by all the component’s of Korsakoff’s psychosis.
The diagnosis was obvious, as was the cause--thiamine deficiency.
As was the relationship of her acute disorder to her present state--she had the memory loss and imbalance characteristic of patients who survive severe Wernicke-Korsakoff syndrome.
“Had there been any malpractice?” Jeff asked me.
“Of course.”
“By whom?”
“All of them. Onslow should have known that gastric resections can cause vitamin deficiencies that can result in severe neurologic problems.”
“But hes’ a surgeon, not a neurologist,” Jeff protested, playing devil’s advocate.
“It’s his business to know the complications of his procedure. Besides, many relevant cases have been published in the surgical journals. Surgeon’s are supposed to read those journals. She was losing weight at a horrendous pace and vomiting. She should have been getting vitaimns as soon as she started vomiting.”
“He gave her a prescription for multivitamin capsules. Extra strength.”
“Not a prescription for capsules--whatever the strength. Shots. She was vomiting daily. Onslow’s in.”
“Who else?”
“Lyons. He referred her for surgery and continued to follow her. It’s his business to know the complications.”
“Lyons is in, then,” Jeff agreed.
“Baker as well. He should have made a diagnosis of vitamin-deficiency neuropathy and started treatment the first time he saw her. He also should have made a diagnosis of Wernicke-Korsakoff syndrome as soon as he saw her in the hospital.”
“Baker disagrees. He says Wernicke’s syndrome occurs only in alcoholics. He says he doesn’t even consider that diagnosis unless a patient is an alcoholic.”
“Bull,” I replied articulately. “It was described in nonalcoholics who had persistent vomiting long ago. Every neurologist knows that.”
“How long ago?”
“1877.”
“By whom?”
“Wernicke. In his first patient. She was a young woman who drank sulfuric acid in an attempt to commit suicide and screwed up her stomach and esophagus. Every time she tried to eat, she vomited. Just like Pat Seerey,” I editorialized.
Was I willing to testify against these physicians?
I was willing. I would not be testifying against physicians, but on behalf of Pat Seerey. And she deserved her day in court.
Pat never got her day in court. The case was settled without a trial. She was awarded more than two million dollars but, of course, she can’t remember how much money she recieved or why.
She thinks it’s 1967.
She only recognizes people she met before the surgery.
She has no idea who Jeff Wright is or what he does for a living. Or who I am. Or who Jack Onslow is.
But she is down to 141 pounds--not counting her wheelchair.
Author’s Note
The neurologic complications of gastric surgery for morbid obesity have been described only in medical literature. The most recent compilation is: J.M. Abarbanel et al., “Neurologic Complications after Gastric Restriction Surgery for Morbid Obesity,” Neurology 37 (1987); 196-200.
An English translation of Korsakoff’s original paper is available: M. Victor and P.I. Yakolev , “S.S Korsakoff’s Psychic Disorder in Conjunction with Peripheral Neuritis,” Neurology 5 (1955): 394-406.
Thanks for that.. i'm much more interested in Thiamine now than i was before read it.
Thank you - that’s an eye opener!! My mum has severe neuropathy - her feet are pretty much numb!
Really interesting. I am aware that a lot of Parkinson’s sufferers include large doses of B1 thiamine in their ‘stack’.
I can no longer drink…! I had half a bottle of beer at a wedding and had to stop because I was aware I was starting to slur! 😳 I have to get my kicks from Diet Coke now… I miss the rock n roll days! X
If we add say wine to a dish while cooking it, or pour brandy on the Christmas pud, and then set fire to it, the alcohol in both cases is burned off. My theory is that people with a low thyroid function have less heat, and do not 'burn off' alcohol as well as healthy people, thus suffer worse hangovers. Only my theory, but it does stand up to logic.
That's going to be my excuse from now on. Yes it does seem a logical intuitive stand point
🤔 ok I’ll go with that!
I have one G&T and that’s it! I feel awful. I think it’s something to do with the liver and the production of thyroid hormones. Ie alcohol reduces the livers capacity to produce what we need as it’s dealing with the alcohol toxins!
I used to have terrible hang overs and get very drunk very quicklythis changed when I started on Levothyroxine and got my optimum dose.
When I go out with my friends I can get drunk but not like I used to.
I also don't get hungover anymore. I do feel lethargic and listless but not the banging headaches that lasted all day.
I now know that the gluten in beer affects me as well, making my head feel very fuzzy. I thought this was normal but it isn't.
I now drink wine and not excess. I can get merry and enjoy it. Those few times I drink to excess, I am fatigued and listless so I plan the recovery time.
I do have a couple of lagers from time to time but mostly drink wine. Chilled white wine is good for summer as a more than adequate substitute for lager.
I’ve always been bad with alcohol. Was severely ill when I was 18 on 2 vodka based cocktails and 4 glasses of wine all over 6 hrs (plus food). I know it was mixing my drinks (didn’t at the time) but I was sick for 3 days.Never had much alcohol since then as it just doesn’t suit me.
From age of about 35 started getting headaches with wine.
Not diagnosed till I was nearly 50, basically teetotal from about 45. Just not worth the hassle any more, feel unwell without the added aggro from alcohol.
Well you know if we had no reaction we’d possibly drink to excess so maybe that’s a bonus! When on holiday and stress free I’m ok it seems so stress possibly doesn’t help!
Can very much identify with this. I now feel hangover symptoms set in while still drinking and can’t tolerate more than 2/3 drinks. Way I see it is, if I’m only having 2, I can have a couple of glasses of the more expensive wine on the menu or a fancier cocktail. Quality, not quantity is the game now!
Beer=Gluten=No good for Hashi's=Not feeling well. Try a gluten free beer/vodka next time and see if it makes a difference. Sorry it put a damper on your fun day.
I've noticed that since I've been on levothyroxine that I can tolerate alcohol much better. I hardly get hangover nowadays not like I used to. I'm not 100% sure I've got hashimoto but my doctor said it's the most probable cause.
How’s the head now?? 🤪 I’ve never had a hangover in my life I must be a fish hahaha
Psychiatric problems with hashis 18 months on from starting levo. Any suggestions?
Consultation with surgeon for partial thyroid removal.
Upped liothyronine dosage- side effects
My symptoms are worse!
Mornings Are The Worse Time
