A new study has raised concerns that people using weight loss drugs may, in rare cases, develop Wernicke encephalopathy, a potentially fatal brain disorder.

Wernicke encephalopathy is a neurological condition marked by profound confusion and disorientation that can steadily deteriorate if it is not treated.

The disorder is triggered by a deficiency of thiamine, also known as vitamin B1. The nutrient, found in foods including meat, fish and whole grains, is essential to normal brain function.

In cases not associated with GLP-1 medications, patients are typically middle-aged people with alcohol use disorder, which may impair the body’s ability to absorb nutrients, or those with another illness that affects nutrient absorption in the intestines.

However, Israeli researchers say they identified 15 cases of the condition in people who were taking GLP-1 weight loss drugs.

Eight patients had been taking semaglutide, the active ingredient in Ozempic and Wegovy, before receiving their diagnosis. Six were using tirzepatide, found in Zepbound and Mounjaro, while one patient was taking liraglutide, the active ingredient in the older weight loss drug Saxenda.

The patients had an average age of 59 and had used the medications for roughly five months before developing Wernicke encephalopathy. All had also reported symptoms including gastrointestinal problems.

Dr Dana Lev, an internal medicine specialist at Sheba Medical Center and the study’s first author, wrote with colleagues: ‘Wernicke encephalopathy is a potentially rare but severe adverse event of [weight loss drug] treatment.

‘As early detection may prevent [progression], increased clinical awareness is warranted, especially in individuals experiencing severe gastrointestinal symptoms.’

The study only detected an association and does not prove that weight loss drugs cause this potentially deadly brain disorder. 

But it is a potential warning signal for clinicians, who are being urged to be aware that patients could develop the condition.

Most of the reported cases came from the FDA’s Adverse Event Reporting System, which is used to report potential side effects from medications. 

Reports in this system are unverified because anyone can submit a report. It was set up to act as a crude early warning system for potential drug side effects.

In the study, published in the journal Clinical Nutrition, difficulty walking and confusion were the most common symptoms recorded in patients before diagnosis, with each suffered by seven patients.

Abnormal mental status and paralysis or weakness of the eye muscles were the second most common, each reported in three patients.

Before the patients were diagnosed with the condition, six reported suffering from vomiting, while five suffered from decreased appetite and malnutrition and three suffered from gastroparesis, or paralysis of the stomach. 

Almost all the cases reported in the study occurred during the reporting year 2023 to 2024. One was recorded during the reporting year 2017 to 2018. 

Ten were recorded in the US, while two each were in Europe and Asia and one was reported in South America.

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Of the nine patients with prescription information available, four had been prescribed weight loss drugs for their diabetes, three had been prescribed them for weight loss and two had been prescribed them for both weight loss and diabetes.

Eight of the cases were reported by clinicians, while four were reported by healthcare providers and three by consumer attorneys. 

It was not clear what may have caused the patients to develop the condition, but the researchers said it could be linked to deficiencies.

They wrote: ‘The prominent weight loss associated with [weight loss drug] treatments alongside the relatively frequent gastrointestinal side effects provides a biologically plausible basis for our findings and suggests increased susceptibility to nutritional deficiencies, including thiamine depletion.’

Although vitamin B1 is vital for the body, it cannot make it itself – instead humans rely on animal and plant sources to ensure a sufficient intake. 

Almost everyone gets enough of this vitamin from a standard diet, but weight loss drug users often consume significantly less food than others, putting them at risk of vitamin and mineral deficiencies.

They may also have gastrointestinal problems, which affect nutrient absorption, and vomit regularly, which also reduces the amount of vitamins their body absorbs, raising the risk of deficiencies.

Wernicke encephalopathy has already been linked to patients who undergo bariatric surgery, which can cause malnutrition because a patient cannot eat standard meals for six to eight weeks after the procedure.

Estimates suggest up to 18 percent of bariatric surgery patients develop some degree of vitamin B1 deficiency, raising the risk of suffering from the neurological condition.

Scientists noted, however, that the 15 cases among weight loss drug users were reported out of the millions already taking the medication.

Estimates suggest 30 million Americans have used a weight loss drug at least once to date, equivalent to 11 percent of the population.

Doctors say people with Wernicke encephalopathy have three main symptoms: confusion, inability to coordinate movements and visual changes.

If these symptoms are left untreated, they cause lasting damage to brain and nerve cells, leading to a second condition, Korsakoff syndrome, which causes severe memory loss and the inability to form new memories. 

The condition is fatal because it raises the risk of injury and incapacity, which can be life-threatening. It also leaves an individual unable to look after themselves. 

Studies suggest up to two percent of people worldwide suffer from Wernicke encephalopathy, although it isn’t clear how many people may have the condition in the US.

Doctors can slowly reverse symptoms of the condition by administering vitamin B1 as pill supplements or injections. 

If someone has suffered brain damage already due to the condition, however, they will not be able to completely cure the condition.

Counseling for alcohol use disorder or nutritional support can help to prevent the disease. 

Autumn 2007 found Gordon Brown close to triggering a surprise general election.

Labour had already produced its campaign literature, while around 100 helicopter slots at Battersea Heliport were reserved to fly Cabinet ministers into key marginal seats across the country.

Hundreds of party workers had also been instructed to prepare for deployment to Labour’s purpose-built election hub, with just 24 hours’ notice.

Yet the order was never given. With Brown seemingly heading towards an election that could have left them facing defeat, David Cameron and George Osborne mounted a last-ditch counteroffensive. In his Conservative conference address, Osborne promised that, if he became Chancellor, he would lift the Inheritance Tax threshold to £1 million. “Only millionaires will pay inheritance tax,” he declared.

The pledge struck an immediate chord with voters. Polling in the following days showed the Conservatives gaining substantial ground in marginal seats. Soon afterwards, Brown quietly abandoned plans for a snap poll, and the episode sent his personal approval ratings into a decline from which they did not recover.

Now, with another Conservative Party conference drawing near, Kemi Badenoch has a chance to deliver a similarly defining announcement—one that could reshape the political contest.

My colleague Gabriel Millard-Clothier revealed exclusively in The Mail on Sunday at the weekend that the Tory leader is considering the complete abolition of Inheritance Tax.

Publicly, Badenoch would say only: “I’ve asked my team to explore fiscally responsible ways to address this burden.” Privately, however, aides indicated that ending the tax is under serious consideration. “When she announced the abolition of stamp duty in last year’s speech, it was the moment her personal approval rating began to turn,” one ally said. “We think a big policy announcement like this could potentially have the same impact for the party as a whole. It’s a way of communicating, ‘OK, the traditional, solid, tax-cutting Tory party really is back.’”

That is why Badenoch should ask her advisers to complete their work, settle on a final proposal and ensure an Inheritance Tax policy is ready for her conference speech next month.

There is currently a policy vacuum sitting at the heart of British politics. Andy Burnham began his premiership by stating that we would have to wait until ‘later this year’ to hear his ten-year plan for the nation.

And, like the Chief in the Asterix comics who fears the sky may fall on his head tomorrow but reassures himself with the fact that tomorrow never actually comes, ‘later this year’ is proving to be an elastic deadline.

Badenoch has a golden opportunity to fill that Burnham-shaped void with a stance that is bold, radical and populist. She also has an opportunity to put some distance between herself and a Prime Minister who seems increasingly intent on leaning heavily on his party’s socialist traditions.

Perhaps even more crucially, she has an opportunity to define herself against the political threat to her Right.

This week has been dominated by the row over Reform’s acceptance of a combined £72million donation from two British crypto billionaires recently based abroad. But what was even more significant was Reform’s bone-headed reaction to Badenoch’s Inheritance Tax proposal.

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One would expect a party that aspired to replace the Conservatives as the main opposition to an old-school, tax-and-spend Labour government would have recognised and embraced a policy that sought to reduce the tax burden on hard-working families. Instead, the party’s treasury spokesman Robert Jenrick made the incomprehensible statement that he believed the plan was ‘morally wrong’. It was, he said, ‘a tax cut predominantly for the well-off’.

Had Jenrick simply dismissed the proposal as something that did not align with Reform’s current fiscal priorities, that would have been one thing. But to claim there is something inherently immoral in people simply aspiring to pass on more of their wealth to their children was a staggering assertion. And one that is likely to cost him and his party dear.

Whether a policy pledge by Badenoch along these lines will have the same transformative effect on Tory fortunes as George Osborne’s momentous announcement almost two decades ago, is open to question. But now is not the time for timidity.

Because despite the denials, the plan taking shape inside Downing Street is clear. Burnham is preparing to call a snap election in the spring of next year. And, based on the current trajectory of the polls, he will almost certainly win it.

Reform’s collapse in support is accelerating. This time last year the party stood at 31 per cent in the polls, 11 points ahead of Labour and 14 points ahead of the Tories. Now they are two points behind Labour, a slender 4 points ahead of the Conservatives, and trending downwards. In just over a year, they have lost a third of their support, all at a time when Keir Starmer’s premiership was imploding.

Meanwhile, Nigel Farage’s personal approval ratings have become radioactive. According to the most recent poll, 24 per cent of people have a favourable opinion of Reform’s leader, while a staggering 69 per cent view him unfavourably. This represents the worst level of antipathy towards Farage since records began.

On these numbers, the idea of Reform securing a majority at the next election is for the birds. And that’s before you factor in the impact of tactical voting, the likely further erosion of support to Rupert Lowe’s insurgent hard-Right Restore party and the plethora of ongoing investigations into Reform’s increasingly murky finances.

The stark political reality is this: There is only one thing that will stop Burnham from calling a snap election and securing a five-year term in No 10. And that is a recovery for the Tory party along the lines we saw in 2007.

That would not require them to leapfrog Labour immediately.

Even after Osborne’s dramatic announcement, Brown still led in the polls for a time. But the shift in support in battleground seats that the policy precipitated was enough to make him think again.

That’s what the Tories need now. Not a miraculous resurgence. But a policy statement that will capture the attention and imagination of the British people. And that will demonstrate there is a party of the Right that provides them with a genuine and serious alternative to the Burnham government, not just an opportunity to register a protest.

Because Burnham remembers well the moment Brown hesitated – and lost. A member of that administration, he was subsequently asked what he thought about that decision. ‘Momentum is a curious thing in politics,’ he reflected. ‘Thousands of us who’ve worked around these jobs could sit in a room and try to work out how to get momentum and how not to lose momentum, but the truth is it hinges on the most unexpected little moments in politics.’

It will take something significant to force Andy Burnham to abandon his own plan for a snap election. Kemi Badenoch is the only person who could still do it. But she will have to be swift, and she will have to be bold.

Labor has announced a broad overhaul of Australia’s migration system, including plans to prevent international students from bringing family members, reduce access to extended working holiday visas and curb the practice of temporary migrants repeatedly changing visas to remain in the country.

The reforms will also focus on students who switch courses to extend their stay, tougher visitor visa settings, questionable protection visa claims and stronger action against people who remain in Australia after their visas expire.

Home Affairs Minister Tony Burke outlined the measures during an address to the National Press Club on Thursday, while cautioning that excessive cuts to migration could hurt the economy.

‘The times that we’ve had massive reductions too far in immigration have coincided with the worst economic times in Australia’s history. We need to be careful with it, and I’m being careful with it.’

Burke said the government was seeking to draw a sharper line between temporary and permanent migration pathways.

‘If you want to come on a temporary basis to Australia, apply for a temporary visa. If you want to come to Australia permanently, apply for a permanent visa. And if you no longer have a valid visa, you should leave Australia,’ he said.

Among the most significant changes, international students and graduate visa holders will no longer have an automatic right to bring family members to Australia.

‘For international students, we will no longer be allowing the attaching of family members for international students or for graduate visas,’ he said.

The changes will not affect partners or family members who are already in Australia on an existing visa.

Working holiday-makers will also face tougher rules when seeking to remain in Australia for a second or third year.

Backpackers will no longer automatically receive another working holiday visa even if they complete the required regional work. Instead, eligible applicants will enter a ballot.

The number of second-year visas will be capped at 45,000, compared with about 57,000 people who qualified last year.

The cut will be much sharper for third-year visas, with just 5,000 places available, compared with about 31,000 people who qualified last year.

‘Not everybody will get through because we need to have some control and certainty of what those numbers are.’

Visitor visas will also be tightened to prevent people entering Australia as tourists and then switching to another visa while onshore.

At present, a visitor can apply for another visa after arriving in Australia and potentially remain on a bridging visa while that application is processed.

Burke said the practice had contributed to visa-hopping and made authorities more reluctant to approve some genuine visitor visa applications.

Under the new system, many visitor visas will carry a ‘No further stay’ condition, generally preventing holders from applying for another visa while they remain in Australia.

International students will also be prevented from repeatedly moving between courses at the same or lower qualification level in an attempt to extend their stay.

‘You can go up the qualification scale, but only up the qualification scale,’ he said.

‘So, at the end of a bachelor degree, if you want to then do a master’s, that’s up the scale, that’s ok.’

Burke said the government was targeting cases where students finish one course before enrolling in another, often cheaper or lower-level qualification primarily to remain in Australia and work.

‘One of the classic areas of Visa hopping is people finish a course, hop to the next course, hop to the next,’ he said.

He said some students were moving to questionable education providers that offered cheaper courses with minimal attendance requirements.

‘Study with me. It will cost you less. We’re not very demanding on whether you attend anything. And you’ll be able to go for your life and get out there and work.’

The government is also planning a crackdown on what Burke described as disingenuous protection claims lodged by temporary migrants who have exhausted other options for remaining in Australia.

He said some applicants were being encouraged to lodge asylum claims despite having little prospect of success because the appeal process could allow them to continue living and working in Australia for years.

‘Put one in anyway and you’ll be able to wait out the appeal system, wait out the court system, you might get up to nine years working in Australia.’

Migration agents who encourage clients to lodge bogus claims could also face sanctions or deregistration.

The government will also ramp up enforcement against visa overstayers, with Burke seeking to revive the approach used before 2015 of directing people whose visas have expired to leave Australia and potentially detaining those who refuse.

An additional 100 compliance officers and 250 detention beds will be added to support the crackdown.

The government is examining existing facilities near airports as well as the former Melbourne quarantine facility for additional detention capacity.

Despite the crackdown, Burke rejected claims Australia was experiencing mass migration.

‘There are parts of the world where mass migration is something that they are dealing with. It is not something we’re dealing with in Australia,’ he said.

‘There was a peak post-pandemic, which was too high. There are reasons why it was too high and reasons why, logically, there was always going to be a peak.’

Burke also defended immigration as critical to the Australian economy, arguing that both regional communities and major cities relied heavily on overseas workers and international students.

‘It is true that immigration is critical to the economy of our regions. It is also true that immigration is critical to the economy of our cities as well,’ he said.

He said international education supported jobs far beyond universities, including cleaners, maintenance workers and businesses.

‘There’s a whole section of the economy in the cities that is only there because we have an important export industry in international students,’ Burke said.

‘Drastic cuts, wherever you make them, hurt the economy in every part, in every area.

‘We talk about the need for extra housing. It’s pretty hard to get a house built without having a plasterer involved.

‘In both Sydney and Melbourne, close to two-thirds of the plasterers we have were born overseas.

‘We need immigration. We just need to make sure that it is targeted to Australia’s needs, both in terms of numbers and across the different categories that work for our economy.’

Burke suggested the wrong type of migrants were often staying. 

‘There are individuals who would never, in fact, meet the qualifications to be able to become a permanent resident, and effectively jump from visa to visa, use the appeals process to be able to stay here as long as possible,’ he said.

‘It eventually becomes absurd not to just let them stay because, at that point, they have Australian-citizen children and, at that point, they are so integrated into a local community.’

Burke also rejected claims Australia’s housing shortage was primarily caused by immigration, arguing that falling household sizes had played a major role.

‘Housing, and the housing shortage we have, is not caused by immigration.

‘Anyone who looks at the migration program and wants to somehow say it was their fault, no. Australians have made a decision about how many people they want per household.’