After Gastric Bypass: The Serious Risk Of Vitamin Deficiencies

Vitamins Are Essential After Gastric BypassThis is something that anyone considering weight loss surgery MUST seriously consider. It is perhaps the most sobering of all risks, because this gastric bypass surgery complication can sneak up on you without much warning. And the consequences are dire.

The “bypass” part of gastric bypass involves bypassing the first section of the large intestine. This is where a good bit of your nutrients are absorbed into your bloodstream.

So you have to be very diligent about taking supplements FOREVER in order to prevent serious deficiencies. Life-altering deficiencies. Life-ENDING deficiencies.

This is something that I’m concerned about since I have such a hard time remembering to take meds of any kind. And the scary part is you don’t notice the problem until it’s a BIG problem.

For example, I found the following report at this link:

Thiamine Deficiency May Complicate Gastric Bypass  CME

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Disclosures

Release Date: December 30, 2005Valid for credit through December 30, 2006

Dec. 30, 2005 — Thiamine deficiency with a nonclassic presentation may follow gastric bypass for obesity, according to a case report in the December 27 issue of Neurology.

“The neurological complications following gastric bypass surgery are diverse,” coauthor Raul N. Mandler, MD, from George Washington University in Washington, DC, said in a news release. “Vitamin B1 deficiency and Wernicke encephalopathy should be carefully considered in surgically treated obese patients.”

The authors describe a 35-year-old woman who developed many symptoms following bariatric gastric bypass, including nausea, anorexia, fatigue, apathy, hearing loss, psychomotor slowing, forgetfulness, ataxia, and bilateral hand paresthesias. By the twelfth postoperative week, she had lost 40 lb and had lethargy, confusion, and difficulty walking, which necessitated hospitalization.

Examination showed inattention, fluent speech with decreased comprehension, decreased hearing, strength 3/5 in the lower extremities, vibratory sense decreased in the feet, deep tendon reflexes absent, and wide-based gait. Laboratory abnormalities were a slight elevation in liver enzymes, high serum glucose level (163 mg/dL), and low serum potassium level (2.6 MEq/L). Her mental status continued to decline despite treatment for dehydration.

When hospitalized, her heart rate was 125 beats per minute; she opened her eyes to nail bed pressure but followed no commands and was nonverbal. Pupils were round and fixed at 3 mm; oculocephalic and deep tendon reflexes were absent; and general muscle tone was flaccid without spontaneous movements or withdrawal to painful stimuli. Cerebral spine fluid protein level was 90 mg/dL, and there was diffuse slowing on electroencephalogram.

Brain magnetic resonance imaging (MRI) revealed bilateral symmetric hyperintense signal on T2-weighted and fluid attenuated inversion recovery images at the floor of the fourth ventricle, periaqueductal gray matter, the medial portions of both thalami, and the premotor and motor cortices, with contrast enhancement in all T2 hyperintense regions.

When she was given intravenous (IV) vitamin B1, 100 mg every 8 hours, her oculocephalic reflexes gradually returned to normal, and she eventually became responsive. Follow-up brain MRI 11 days after thiamine repletion showed interval improvement, with less contrast enhancement, but with increased signal on precontrast T1-weighted images in the premotor and motor cortices, likely representing petechial hemorrhages.

“Wernicke encephalopathy is a well-defined syndrome, but difficult to identify in the absence of the classic triad of oculomotor abnormalities, ataxia, and confusion,” the authors write. “When a patient presents with unusual symptoms (in our case with progressive hearing loss, most likely secondary to thalamic involvement), then blood work (red blood cell transketolase levels) and MRI become helpful tools in making the diagnosis.”

The authors have disclosed no relevant financial relationships.

“This case highlights the variability of Wernicke encephalopathy where the classic trio of eye movement abnormalities, confusion, and ataxia are seen in less than 20% of patients,” says Heidi Schwarz, MD, who wrote a related commentary. “It is unusual because the patient also had hearing loss.”

Dr. Schwarz notes that bariatric surgery may have other complications, including anemia, vitamin D deficiency and bone resorption, rhabdomyolysis, vitamin A deficiency, and hypocalcemia. Neurologic complications are common, especially when there is intractable vomiting causing myelopathy and ataxia due to deficiencies in vitamin B12, copper, or vitamin E; or peripheral neuropathy, plexopathies, and mononeuropathies due to vitamin or micronutrient deficiencies or as yet unknown causes.

“Although thiamine deficiency was not documented serologically [in this case report], the course, MRI findings, and response to thiamine establish the diagnosis,” Dr. Schwarz writes. “Patients who have had bariatric surgery require a high index of suspicion for Wernicke encephalopathy so that prompt treatment can be given to prevent devastating and often permanent disability.”

Isn’t that horrible? This woman could have died before they figured out what was wrong with her. Can you imagine how scary that would be?

Here is a list of possible vitamin deficiencies and their symptoms from Sinai Hospital in Baltimore:

Thiamine (B1) deficiency = Beri-Beri = anorexia(loss of appetite), altered heart rate, right sided heart failure, edema, and muscle weakness, nerve problems

Riboflavin (B2) deficiency =magenta tongue (purple color), chelosis (dry cracked lips), nervous system problems, eye sensitivity to light, skin rashes

Niacin(B3)deficiency = Pellegra=Red neck, diarrhea, dementia, dermatitis (red crusty skin where areas of sunlight strikes it)

Biotin (B4) deficiency =dermatitis (dry scaly skin), alopecia (hair loss) Pantothenic Acid (B5) deficiency=intestinal distress (vomiting) fatigue, insomnia

Vitamin B6 deficiency =insomnia, fatigue, dermatitis, glossitis (sore tongue), depression, confusion, convulsions, anemia

Folic Acid deficiency =megoloblastic anemia, impaired protein metabolism, Leukopenia (low white blood cells), thrombocytopenia (bleeding), glossitis (sore/swollen tounge)

Magnesium deficiency =anorexia, nausea fatigue, weakness, seizures, muscle cramping, personality changes, abnormal heart rhythms, coronary spasms, (hypocalcemia) low calcium, (hypokalemia) low potassium

Iron deficiency =anemia, fatigue, dizziness, low blood count and stores

Calcium deficiency =osteopenia, osteoporosis (weak/ broken bones)

B12 Deficiency =Macrocytic anemia (large red blood cells), Leukopenia (low white blood cells), Thrombocytopenia (low blood platelets and bleeding), Glossitis (large sore tongue), Neuro-psychiatric complications (nerve damage, trouble walking, tingling in hands and feet, paralysis-wheel chair)

This is deadly serious and something you MUST consider both when making the decision to have a gastric bypass, and every day afterwards. Can you faithfully take your vitamins? Will you be able to afford them?

As for me, I have to go now. Time to take my vitamins.

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3 Responses to After Gastric Bypass: The Serious Risk Of Vitamin Deficiencies

  1. Since having surgery on Dec. 10th, with all the complications that I have had, I have not been able to take any supplements. Chewable or liquid. My surgeon knows this and we’re working on my physical problems and then we’ll worry about the vitamins.

  2. I never thought the vitiman deficency could be me but now I’m set to see a hemotoligst for a possible blood transfusion. I’m almost 7 years out and have never had the first problem. I had not had my blood work done for a couple of years and was shocked this time…. Wow take those vitimans without fail, I’ll never drop that habit again. Thanks for this page it was so helpful.

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