Alcohol, sense of balance, B-vitamins

[Richard Masters]

I attended a special event two weeks ago, and drank enough to pass out. The next morning I drank plenty of water, and thought I felt fine, except for a general deficit in my sense of balance and some trembling (though I can account for the trembling due to being nervous because I had a speaking engagement).

I'm not a frequent drinker, and I've passed out only once before. Last time I drank may have been 6 and 32 months ago.

However, my sense of balance is still a bit off; Should I expect an improvement as my body recovers? I've read about Wernicke-Korsakoff's syndrome* so I've pulled out a bottle of B-vitamins.

Am I going about this the right way? Should I hold off on exercise until I feel a little better?

*I don't think I have WKS, but thiamine supplementation seemed relevant. I've also been on SSRI's for depression/anxiety, so the alcohol may have affected me more severely than a typical drinker, and I want to make sure I get back to baseline soon.

I consider myself informed, but feel free to point out if I'm overreacting or engaging in woo...

Thanks,

-R.

 

[Professor Yaffle]

I doubt it has anything to do with vitamin B1 deficiency. Alcohol seems to cause that only if you are a chronic heavy drinker. If you are worried about your symptoms, you should check it out with a doctor.

 

[wollery]

No need to worry, it's just a normal after-effect of getting completely hammered. Alcohol is a poison, and it takes time for your body to recover fully and flush all of the alcohol out of your system.

In fact, your were probably still fairly drunk when you woke up.

 

[Dr. Imago]

I attended a special event two weeks ago, and drank enough to pass out. The next morning I drank plenty of water, and thought I felt fine, except for a general deficit in my sense of balance and some trembling (though I can account for the trembling due to being nervous because I had a speaking engagement).

First off, there's Wernicke's, then there's Korsakoff. Wernicke's is more acute and due to lack of adequate energy transfer in neurons, probably globally, but most noticeably within the basal ganglia and the cerebellum. Korsakoff's is when you confabulate (I've seen it once in clinical practice) because your memory is shot. It's really interesting. The guy I saw would completely make-up a story when asked something random. I asked him about his grandchildren (he didn't have any) and he went on-and-on for about 5 minutes about how they were both so beautiful and made him proud. Korsakoff's is chronic and takes a long bout of malnutrition (months to years) to get that way. These disorders often get jammed together, because many chronic drunks present with both.

Secondly, what was your blood sugar in the morning? Are you a diabetic? How much did you drink? What happens when we drink heavily is we completely screw up (even temporarily) our metabolism. You pee like crazy because the substance that regulates body water, called ADH, is inhibited from being released from the pituitary gland. The result is often a massive diuresis, including the fluid around your brain. The headache that results from hangover can come from both toxins in whichever alcohol you were drinking (e.g., for me, whatever was in that burnt oak barrel that the bourbon was sitting in is an instant trigger... even just one bourbon drink and, BLAMMO, headache and illness for me) or from stretching on your dura, the sack that covers your brain and spinal cord, which is the only pain-sensitive structure around the brain, which is a result of that loss of total body water.

You also disrupt normal energy metabolic pathways. Plus, you probably didn't eat adequately as you were boozin' it up. Alcohol becomes the energy substrate (and, ironically, it's not that bad of one), and your body breaks this down first to acetaldehyde then to vinegar (I know it's not really vinegar, pedants, but acetic acid, which is a constituent in vinegar that gives it its pungence), which is either used for energy or excreted. Acetaldehyde, similar structurally and functionally to formaldehyde (which our body also makes in micro quantities), also adds to the hangover.

All these things probably combined to make you feel the way you did. You don't always need or get the headache to have a whopper hangover.

Long story short, if you are otherwise healthy and eat properly most of the time, Wernicke-Korsakoff is likely not the problem. The fact that you are posting here and able to discuss it cogently kind of rules that out. But, you shouldn't binge drink and you should still make sure that you have no other underlying health problems. I suggest a routine physical, if you haven't had one, as everyone can benefit from knowing where they stand healthwise with even the simple stuff (blood pressure, cholesterol level, etc.).

~Dr. Imago

 

[Richard Masters]

I doubt it has anything to do with vitamin B1 deficiency. Alcohol seems to cause that only if you are a chronic heavy drinker. If you are worried about your symptoms, you should check it out with a doctor.

Thanks, I was reading too much into WKS and didn't notice until you pointed it out.

No need to worry, it's just a normal after-effect of getting completely hammered. Alcohol is a poison, and it takes time for your body to recover fully and flush all of the alcohol out of your system.

In fact, your were probably still fairly drunk when you woke up.

Yes, I was still drunk after I woke up. I'm just being extra cautious since I've had to deal with cognitive deficits from the clinical depression and don't want to exacerbate them. (Obviously getting hammered was a bad choice, fortunately, I'm not interested in doing it again).

 

[Richard Masters]

First off, there's Wernicke's, then there's Korsakoff. Wernicke's is more acute and due to lack of adequate energy transfer in neurons, probably globally, but most noticeably within the basal ganglia and the cerebellum. Korsakoff's is when you confabulate (I've seen it once in clinical practice) because your memory is shot. It's really interesting. The guy I saw would completely make-up a story when asked something random. I asked him about his grandchildren (he didn't have any) and he went on-and-on for about 5 minutes about how they were both so beautiful and made him proud. Korsakoff's is chronic and takes a long bout of malnutrition (months to years) to get that way. These disorders often get jammed together, because many chronic drunks present with both.

I love responses like this: Not only is it relevant to my question, but I get to learn all kinds of interesting, related information.

Secondly, what was your blood sugar in the morning? Are you a diabetic? How much did you drink?

I wouldn't know how to gauge my blood sugar level, so it's hard to say without some guidance; however, I'm not diabetic. I probably drank over 12 shots between 2200 and 0200, however the last few were in rapid succession, which would explain the black-out.

What happens when we drink heavily is we completely screw up (even temporarily) our metabolism. You pee like crazy because the substance that regulates body water, called ADH, is inhibited from being released from the pituitary gland. The result is often a massive diuresis, including the fluid around your brain. The headache that results from hangover can come from both toxins in whichever alcohol you were drinking (e.g., for me, whatever was in that burnt oak barrel that the bourbon was sitting in is an instant trigger... even just one bourbon drink and, BLAMMO, headache and illness for me) or from stretching on your dura, the sack that covers your brain and spinal cord, which is the only pain-sensitive structure around the brain, which is a result of that loss of total body water.

You also disrupt normal energy metabolic pathways. Plus, you probably didn't eat adequately as you were boozin' it up.

Had a couple of salt crackers, during, but no breakfast the next day.

Alcohol becomes the energy substrate (and, ironically, it's not that bad of one), and your body breaks this down first to acetaldehyde then to vinegar (I know it's not really vinegar, pedants, but acetic acid, which is a constituent in vinegar that gives it its pungence), which is either used for energy or excreted. Acetaldehyde, similar structurally and functionally to formaldehyde (which our body also makes in micro quantities), also adds to the hangover.

All these things probably combined to make you feel the way you did. You don't always need or get the headache to have a whopper hangover.

Long story short, if you are otherwise healthy and eat properly most of the time, Wernicke-Korsakoff is likely not the problem. The fact that you are posting here and able to discuss it cogently kind of rules that out.

Good to know!

But, you shouldn't binge drink and you should still make sure that you have no other underlying health problems. I suggest a routine physical, if you haven't had one, as everyone can benefit from knowing where they stand healthwise with even the simple stuff (blood pressure, cholesterol level, etc.).

Will do as soon as possible (no health insurance at the moment, despite having a return visit with a specialist coming up soon)

~Dr. Imago

Thank you for your insight. Interesting to read, too.