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The researchers said increased awareness and basic screening for Vitamin B1 deficiency in high-risk patients could prevent neurological damage.
By Shula Rosen
A study launched at Sheba Medical Center after an unusual hospital admission is raising new questions about a rare but serious brain complication that may occur in uncommon cases among users of popular GLP-1 weight-loss drugs, particularly when rapid weight loss and prolonged vomiting are involved, Ynet reports.
The research began when a young woman was admitted to Sheba’s internal medicine department with confusion, difficulty walking and visual problems.
Doctors suspected Wernicke’s encephalopathy, a life-threatening neurological condition caused by severe vitamin B1 deficiency. Tests showed no alternative explanation for her condition but revealed that she had recently started a GLP-1 medication, lost weight quickly and experienced repeated vomiting. Her vitamin B1 levels were low. After receiving intravenous vitamin B1, her condition improved.
The case prompted Dr. Adam Goldman, an internal medicine physician and gastroenterology fellow at Sheba, to lead a wider investigation with colleagues from the hospital’s internal medicine and nutrition teams, alongside Dr. Dana Lev. The researchers reviewed reports from the FDA’s adverse event database and examined published medical literature to assess whether similar cases had been documented.
Their review identified 15 reported cases of Wernicke’s encephalopathy following treatment with GLP-1 drugs.
Eight cases were linked to semaglutide, sold as Ozempic or Wegovy; six followed use of tirzepatide, sold as Mounjaro; and one involved liraglutide, marketed as Victoza. In most cases, patients experienced persistent vomiting, rapid weight loss or malnutrition. Many did not display all the classic symptoms of the condition, making diagnosis more difficult.
Among 11 patients for whom follow-up information was available, seven were left with lasting neurological damage. The researchers stressed that the findings do not prove that GLP-1 drugs cause the condition and do not indicate how common it may be.
“GLP-1 medications are among the most effective tools we have for treating obesity and diabetes, and most patients use them safely,” Goldman told Ynet. “But this case shows the importance of paying close attention when patients experience vomiting, rapid weight loss or poor nutrition. Vitamin B1 deficiency can develop quickly, and if it’s caught early, a severe neurological complication can often be prevented with simple treatment.”
Goldman said Wernicke’s encephalopathy was long associated mainly with alcoholism, but is now known to appear in other situations involving nutritional deficiency, such as after bariatric surgery. He said a similar mechanism may apply here.
The study found no international guidelines requiring routine vitamin monitoring for patients on GLP-1 drugs. The researchers said increased awareness and basic screening for vitamin B1 deficiency in high-risk patients could prevent rare but potentially irreversible harm, while emphasizing that GLP-1 medications remain safe and effective for the vast majority of users.
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