Thiamin (Vitamin B1) Deficiency Before and After Bariatric Surgery

Pre-Operative Deficiency

Thiamin plays an important role in energy metabolism (through the metabolism of glucose) and cell functioning in the body; it's essential for tissues and organs to function properly. A thiamin deficiency can lead to cardiac and neurological abnormalities¹. Thiamin is not stored in large quantities in the body. The half-life of thiamin is only a few weeks, so dietary and supplemental intake is imperative.

Food sources that contain thiamin are whole grains, meats and seafood, and fortified foods, such as breads and cereals; for some foods, many patients are not able to obtain them within their financial constraints.

In a study by Flancbaum et al, preoperative deficiency rates for thiamin are noted to be 29%, with Hispanic and African American patients having higher prevalence of thiamin deficiency (47.2% and 31%)². Likewise, another study conducted on over 300 patients in the pre-operative phase for bariatric surgery found forty-seven (15.5%) of the study participants to have low thiamin levels, the majority being female patients³.

Post-Operative Deficiency

Deficiency in thiamin can lead to Wernicke-encephalopathy, wet Beriberi, and ultimately death, if left untreated. Wernicke-encephalopathy is diagnosed by a change in mental status, ocular movement abnormalities, and ataxia. Early onset symptoms of thiamin deficiency are non-specific and can include fatigue, lethargy, uneasiness, and headaches⁴. If left untreated, symptoms can progress to congestive heart failure or wet beriberi, peripheral neuropathy, dysphagia, depression, or Korsakoff syndrome⁴. Kröll et al. developed an overview of Wernicke-Encephalopathy after sleeve gastrectomy (Table 1)⁴.

Progression of Wernicke-Encephalopathy after Sleeve Gastrectomy

Adapted from Kröll, Dino & Laimer, Markus & Borbély, Yves & Laederach, Kurt & Candinas, Daniel & Nett, Philipp. (2015). Wernicke Encephalopathy: a Future Problem Even After Sleeve Gastrectomy? A Systematic Literature Review. Obesity surgery. 26. 10.1007/s11695-015-1927-9.

Bariatric surgery procedures can increase the risk of thiamin deficiency due to nausea and vomiting, rapid weight loss, and excessive alcohol intake⁴. Since thiamin is a water-soluble vitamin, daily intake is needed to maintain normal serum levels, in fact, Sechi et al. found that lack of thiamin intake can lead to a deficiency in as few as 20 days without appropriate thiamin supplementation⁵. Angelou et al. found Wernicke encephalopathy onset occurred as early as 2 weeks and as late as 60 weeks after sleeve gastrectomy⁶

Postoperative thiamin deficiency was found to be as great as 25% in patients up to 2 years post-op and ranged from 0-30.8% by the 5-year mark, regardless of supplementation⁷. A study conducted by Johns Hopkins University found that out of 105 patients post-sleeve gastrectomy, patients with a higher BMI and/or were of a minority ethnicity had a higher risk of developing thiamin deficiency: 20% at 3 months, 17% at 6 months, and 20% at 12 months post-surgery, even while taking the recommended 3 mg thiamin supplementation daily⁷.

References:

1. Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part B: minerals. Obes Surg. 2008;18(8):1028‐1034. doi:10.1007/s11695-007-9350-5
2. Flancbaum, L., Belsley, S., Drake, V. et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg 10, 1033–1037 (2006). https://doi.org/10.1016/j.gassur.2006.03.004
3. de Lima KV, Costa MJ, Gonçalves Mda C, Sousa BS. Micronutrient deficiencies in the pre-bariatric surgery. Arquivos Brasileiros de Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery. 2013 ;26 Suppl 1:63-66. DOI: 10.1590/s0102-67202013000600014.
4. Kröll, D., Laimer, M., Borbély, Y.M. et al. Wernicke Encephalopathy: a Future Problem Even After Sleeve Gastrectomy? A Systematic Literature Review. OBES SURG 26, 205–212 (2016). https://doi.org/10.1007/s11695-015-1927-9
5. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6(5):442‐455. doi:10.1016/S1474-4422(07)70104-7
6. Athanasiou A, Angelou A, Diamantis T. Wernicke's encephalopathy after sleeve gastrectomy. Where do we stand today? A reappraisal. Surg Obes Relat Dis. 2014;10(3):563. doi:10.1016/j.soard.2014.01.028
7. 7- Tang L, Alsulaim HA, Canner JK, Prokopowicz GP, Steele KE. Prevalence and predictors of postoperative thiamin deficiency after vertical sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(7):943‐950. doi:10.1016/j.soard.2018.03.024

Thiamine Tablets 100mg (Vitamin B1)

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Our thiamin product contains 100 mg of thiamin vitamin b1 and is available in a small, easy to swallow capsule.… read more

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