What Is Wet Brain? Causes, Symptoms, and Treatment Options

What Is Wet Brain?

“Wet brain” refers to Wernicke-Korsakoff syndrome (WKS), a serious neurological disorder affecting memory, mobility, vision, and cognition.[1] This disorder results from a long-term lack of thiamine (also known as vitamin B1), which is essential for the normal functioning and metabolism of the brain.[2] 

The term wet brain is derived from chronic drinking, which has been found to be by far the primary contributing factor. However, it is necessary to understand that alcohol itself does not directly cause wet brain. Instead, alcohol prevents the body from properly storing and absorbing thiamine.[3] This means that individuals with an alcohol use disorder (AUD) (a condition in which someone is unable to control their drinking) are particularly susceptible to thiamine deficiency. 

WKS is two related yet separate conditions that typically occur in sequence, with one leading to another. Wernicke encephalopathy is the acute, short-term phase, which, if not treated immediately, is followed by the chronic phase, Korsakoff psychosis. Together, they represent one of the most serious neurological outcomes related to years of alcohol misuse.

What Causes Wet Brain?

At its core, wet brain is ultimately caused by thiamine deficiency. 

Thiamine is essential to how the brain converts glucose into energy. If thiamine levels are too low, the brain cells cannot function properly, and as this continues, damage accumulates in the brain, particularly in the thalamus (the region responsible for relaying sensory and motor signals) and the hypothalamus.[4]

Chronic alcohol misuse contributes to thiamine deficiency in a variety of ways:

• Impairing the absorption of thiamine in the gastrointestinal system.
• Reducing the liver’s ability to store thiamine.
• Interfering with the body’s ability to convert thiamine into its active form.
• Contributes to poor nutrition and a poor diet, as heavy drinkers often replace their daily caloric intake from food with calories from alcohol, which inherently reduces thiamine intake.

While alcohol abuse is the leading risk factor for developing WKS, there are other medical comorbidities and lifestyles that can result in a severe thiamine deficiency. These include eating disorders like anorexia nervosa, certain cancers, malnutrition from any cause, prolonged vomiting, medical conditions that impair nutrient absorption, and complications following weight loss surgery. Research published in the journal Neuropsychiatric Disease and Treatment has shown that WKS is underdiagnosed in clinical settings, which results in many cases going undiagnosed or treated until significant neurological impairment has occurred.[5]

Symptoms of Wet Brain

Recognizing the symptoms of wet brain early on is critical because while it is in the Wernicke encephalopathy phase, it can be treated to prevent it from progressing into the far worse and permanent Korsakoff psychosis stage.

Below are symptoms of both stages:

Wernicke Encephalopathy

Wernicke encephalopathy is the acute phase of WKS and is considered a medical emergency. It features a typical triad of symptoms: ataxia (loss of muscle control and balance), confusion or disorientation, and abnormal eye movements. However, the research of the National Institute on Alcoholism suggests that more than 80% of people with WKS do not exhibit all three symptoms at the same time, complicating diagnosis.[6]

Signs of Wernicke encephalopathy include:

• Abnormal eye movement, such as nystagmus (rapid, involuntary eye movement), droopy eyes, and double vision
• Severe problems with muscle coordination, specifically difficulty walking or standing
• Sudden onset of confusion, disorientation, or difficulty concentrating
• Abnormal blood pressure and heart rate
• Extreme fatigue or difficulty staying alert

Without prompt treatment,  Wernicke encephalopathy quickly progresses to Korsakoff psychosis, coma, or, in extreme cases, death.

Korsakoff Psychosis

Korsakoff psychosis is the chronic, long-lasting state of WKS that develops when Wernicke encephalopathy goes untreated or is not treated properly. This stage is characterized mostly by severe memory impairment and changes in behavior. The most telling signs of Korsakoff psychosis are the inability to form new memories, although older memories may remain intact.

People with this condition can experience confabulation (the unconscious production of fabricated or distorted memories to fill in gaps, without any intent to deceive), which may lead to the appearance that the person is lying, when in fact, they are experiencing a symptom of brain damage. Other signs of Korsakoff psychosis include:

• Severe memory loss, particularly for recent events
• Memory gaps that the patient fills in with fabricated information
• Difficulty learning new information
• Apathy, reduced motivation, and personality changes
• Relatively intact social skills compared to the level of cognitive function

Brain damage sustained from Korsakoff psychosis is largely permanent, which is why prevention, recognition, and early treatment of Wernicke encephalopathy is so important.[7]

Can Wet Brain Be Treated or Reversed?

Whether wet brain can be reversed depends a great deal on what phase of wet brain you are referring to.

Wernicke encephalopathy is treatable. Caught and treated early, damage can often be significantly minimized or prevented from progressing. Wernicke treatment consists of administering high doses of thiamine, typically given intravenously in a hospital for rapid absorption. With prompt thiamine replacement, acute symptoms of Wernicke can frequently improve, including the resolution of many eye movement abnormalities and confusion, within a few days.[8]

After the acute phase, ongoing thiamine supplementation will continue to be a key aspect of continued recovery in addition to nutritional support and a balanced diet. It is also very important to treat any medical problems that contributed to the development of WKS. If your wet brain is the result of alcohol addiction, then getting professional help to stop drinking is necessary. Continuing to drink will prevent recovery and may cause even further damage.

Korsakoff psychosis is much more difficult to treat than Wernicke encephalopathy. Once brain damage has occurred, reversing it is typically not possible. However, with long-term thiamine supplementation, nutritional support, and abstaining from alcohol, some patients have shown signs of improvement. Research has found that, with treatment, approximately 75% of people with Korsakoff syndrome demonstrate some degree of improvement, and the remaining 25% show no improvement at all.[9] For those individuals who are unable to recover, care is focused on ongoing support for managing symptoms, supporting quality of life, and an environment that accommodates their memory impairment.

The Connection Between Alcohol Use Disorder and Wet Brain

Wet brain does not happen suddenly; it is the cumulative result of excessive amounts of alcohol being consumed over extended periods of time, combined with malnourishment, a pattern that is common in those with advanced alcohol use disorder. Being aware of this relationship can help to not only reduce the likelihood of developing wet brain, but also aid in determining if someone is at risk.

People who drink heavily over several years, especially if they are malnourished or have an eating disorder, are at the highest risk. The following symptoms may indicate to someone that their thiamine is low enough to put them in serious danger: 

• Weakness in muscles
• Lack of energy
• Changes in vision
• Increasing confusion. 

However, many times individuals can overlook these initial symptoms or mistakenly attribute them to being intoxicated.

With friends or loved ones who are suffering from alcoholism, recognizing these signs and encouraging them to seek help for their alcohol problem as early as possible can be the difference between life and death. Under medical supervision, the detoxification process is the first step in recovery, as withdrawal from alcohol can be life-threatening. Following detoxification, a treatment plan that addresses both the physical and psychological aspects of their addiction should be the next step to give them the best opportunity to recover and maintain long-term health.

Getting Help from The Garden

Wet brain is one of many very serious long-term health complications resulting from an untreated alcohol use disorder. However, it is preventable. By getting help for an alcohol problem before it develops into a serious health condition, you can take back control of your health.

At The Garden Recovery & Wellness in Cherry Hill, New Jersey, we offer compassionate, evidence-based (practical application of the findings of the best available current research) outpatient treatment for alcohol use disorder and co-occurring mental health conditions. Our boutique programs are designed to feel personal and supportive, not clinical or institutional. Whether you are just beginning to consider treatment or are ready to take the next step, our team is here to help. Connect with The Garden today to learn more about how we can support your recovery.