Vitamins Seen Necessary Following Gastric Bypass Surgery

A new study reports that failure to take multivitamins after bariatric surgery can develop rapidly into thiamine deficiency, causing beriberi and encephalopathy.

Researchers at University College London (United Kingdom) described a case report of a 27-year-old woman who, 2 months after uncomplicated gastric bypass surgery suffered from 3 weeks of dizziness, low-appetite, and vomiting. The woman was diagnosed with gastric outflow obstruction, partially due to her rapid heartbeat and dehydration. However, endoscopic examination of the digestive system did not show anything of significance. Blood tests suggested that she was dehydrated, so her physicians gave her intravenous fluids, including glucose, and told her to drink high-sugar energy drinks. These did not work, however, as she felt light headed, fell down in the shower, and had very low blood pressure the next day. Additional tests found abnormal eye movements, hyper-reflexia in her arms, weakness of the thighs, and reduced touch sensation, which pointed towards a deficiency of thiamine (also know as vitamin B1). After administering thiamine intravenously, the patient made a full recovery. She also admitted that she had not been taking her prescribed multivitamins. The study was published in the October 11, 2008, issue of The Lancet.

"Obesity surgery is becoming increasingly common as it is the only effective treatment for morbid obesity and reduces mortality and obesity associated diseases,” said lead author Rachel Batterham, M.D., and colleagues of the division of surgery. "Our case highlights the importance of vitamin supplementation and monitoring of thiamine levels in this patient group. In view of the non-specific nature of the initial beriberi presentation, a low threshold should be adopted for intravenous thiamine administration, especially prior to high glucose loads in patients' post-obesity surgery. This could indeed be lifesaving.”

Vitamin supplements are critical after gastric bypass surgery so that the body receives vitamins that are no longer entering the body through food intake. The body stores thiamine for 18 to 60 days, and deficiency can lead to cardiovascular problems (wet beriberi), nervous system problems (dry beriberi), or an acute neurological disorder with eye movement problems called Wernicke's encephalopathy. The woman analyzed in this study suffered from all three conditions. Alcoholism is the usual condition that is linked to thiamine deficiency, but is also associated with habitually restricted diets, gastrointestinal disorders, cancer, AIDS, severe infection, and kidney disease, as well as gastric bypass surgery.

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