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      • Bariatric Recipes
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      Thiamin (Vitamin B1) Deficiency Before and After Bariatric Surgery

      Nutrition
      September 15th, 2021

      Picture of Chemical makeup of vitamin B1

      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

      Risk factors
      • Recurrent emesis
      • Non-compliance and inadequate vitamin supplementation
      • Preoperative vitamin B deficiencies
      • Surgical complications (stenosis)
      • Parenteral feedings, caloric carbohydrate diet
      • Co-morbidities: alcohol consumption, type 2 diabetes, hepatic stenosis, non-alcoholic fatty liver disease, delayed gastric emptying
      Time of Neurological Symptoms
      • Early: within 2-6 weeks (stores can be depleted)
      • Late: within 7 months with variability, usually within 3-5 months
      Clinical manifestations
      • Wernicke encephalopathy (ocular dysfunction, gait ataxia, encephalopathy) classic triad often not seen
      • Altered mental status changes
      • Korsakoff syndrome (amnestic-confabulatory syndrome)
      • Peripheral neuropathy and polyradiculopathy
      • Nonspecific symptoms: fatigue, lethargy, restlessness
      • Atypical symptoms: vestibular disfunction without hearing loss, dysphagia, depression
      Diagnostic Tools
      • Clinical diagnosis
      • Laboratory examination may not be specific, serum thiamin levels may be reduced
      • MRI may show increased T2 signals in periventricular regions
      Differential Diagnosis
      • Other nutrient deficiencies: vitamin B-12, copper, folate, niacin, vitamin E
      Treatment
      • 500 mg thiamin IV TID for 2 days, followed by 500 mg/d IV or IM for 5 days with magnesium and other B vitamins, followed by long-term oral supplementation of 50 or 100 mg/d
      Outcome
      • Complete recovery is rare

      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

      Thiamin Vitamin B1 100 mg

      Thiamin Vitamin B1 100 mg

      $10.95

      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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