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Nutrition
September 15th, 2021
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.
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
| Risk factors |
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| Time of Neurological Symptoms |
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| Clinical manifestations |
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| Diagnostic Tools |
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| Differential Diagnosis |
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| Treatment |
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| Outcome |
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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:
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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
