Bariatric B1 deficiency, if detected, can be corrected with supplements. Untreated can be fatal.

There has been even more heartbreaking news regarding the two bariatric post ops, one remains in a nursing facility while the other has passed away, both from effects of Vitamin B1 Thiamine deficiency.

The occasional instance of Wernicke's encephalopathy indicates a need for close monitoring and systematic vitamin supplementation in those patients who undergo bariatric surgery

We ask all who have had bariatric surgery to take five minutes to honestly think through your own vitamin compliance. The effects of Wernicke’s Encephalopathy – confusion, loss of muscle coordination, numbness in fingertips, extreme fatigue, and abnormal eye movements – are due to irreversible brain damage caused by a lack of vitamin B1 Thiamine.

While uncommon, this deficiency progresses to coma and death, and we need to familiarize ourselves with the symptoms.

“The tragedy of this disease is that it can be very serious, and you can even die from this,” said Dr. Michael DeGeorgia of the Cleveland Clinic. “But if it’s caught early it can be completely cured. The trick is to recognize it, and what has happened in the past is that people have failed to recognize it, because it’s associated with alcoholism. It’s under recognized in post-gastrectomy patients, or cancer patients, or anybody who is malnourished.”

All it takes to be proactive in avoiding this tragic deficiency is ample preventative dosing of B1 Thiamine, which is part of bariatric multiformula supplements such as Journey. We honestly do not care which bariatric supplement you take, but please make sure that you take one that has B1.

Two beautiful vital women never dreamed anything like this would happen to them. Take a moment to get real with the person in the mirror. Could this have been me? Am I keeping up with taking my vitamins or have I gotten caught up in life and let things slide? Who am I kidding if I do not take vitamins at all, or if I lackadaisically finish a 30-day bottle every four months?

Some who say they cannot afford them were out shopping on Black Friday! Some laugh ‘I don’t take anything and my labs are perfect’. (NO THEY ARE NOT! I guarantee you that) Some make excuses that they have kids who come first, but what happens if you are too sick to function or even die and what if it’s from your own neglect.

Dig up that bottle of bariatric vitamins you bought and start taking them now. We understand it has been difficult using brands that had us taking 6 different bottles of tablets throughout the day. Many of us failed and then just stopped taking them. That is why we worked with specialists in combining multiple nutrients into one product. An investment in precious life, the one we had surgery for, is just a little more than a dollar a day with our Journey 3+3 bariatric vitamins.



Acute Wernicke encephalopathy and sensorineural hearing loss complicating bariatric surgery

Conn Med. 2012 Nov-Dec;76(10):603-5. Jethava A, Dasanu CA.
Department of Hospital Medicine, Saint Francis Hospital and Medical Center, Hartford CT, USA.

Health-care professionals must be aware of the mandatory vitamin supplementation in patient’s status post bariatric surgery. A recent increase in the number of gastric bypass surgeries in US has been associated with a proportional increase in Wernicke encephalopathy reports. Subtle or atypical neurologic features are not uncommon. Our report is of a female patient with acute Wernicke encephalopathy accompanied by sensorineural hearing loss six weeks after bariatric surgery. The patient had only a partial recovery of her neurologic symptoms eight weeks after vigorous therapy for this condition. Symptomatic thiamine (vitamin B1) and vitamin B12 deficiencies are particularly concerning effects of bariatric procedures, as neurologic and cognitive deficits may be long lasting or even permanent despite aggressive replacement therapy.

PMID: 23243762 [PubMed – indexed for MEDLINE]

Neurology: Some Bariatric Surgery Patients Develop Wernicke’s Encephalopathy

By Neil Osterweil , Senior Associate Editor, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine

Action Points

* Explain to patients that in a small number of cases, patients who undergo weight reduction surgery may develop Wernicke’s encephalopathy, marked by confusion and problems with movement and eye control.
* The cause is a thiamine (vitamin B1) deficiency and, if detected, can be easily corrected with dietary supplements. Untreated, it can be fatal and cause severe neurologic morbidity.

Weight-loss surgery may also cause memory loss and other serious neurologic problems in a small number of patients.

At least 32 cases of Wernicke’s encephalopathy — a syndrome caused by thiamine deficiency and marked by acute mental confusion, apathy, drowsiness, ataxia, and oculomotor abnormalities — have been reported in the medical literature in patients who underwent bariatric surgery, found Sonal Singh, M.D., of Wake-Forest University here, and Abhay Kumar, M.D., of the University of Iowa in Iowa City.

A few of the patients suffered persistent memory loss and motor problems, the investigators reported in the March 13 issue of Neurology.

Werrnicke’s encephalopathy, first described in 1881 by Polish neurologist Carl Wernicke, M.D., is frequently seen among alcoholics, those with nutritional deficiency states, AIDS patients, and people who are on long-term hemodialysis, but its incidence in bariatric surgery patients had been unknown.

“The purpose of our study was to get at the clinical features of the syndrome, the characteristics, and how it could be prevented,” said Dr. Singh. “We were not in a position to say anything about the incidence; there are no studies of how common it is. Prospective long-term studies will really tell us whether this is rare.”

But a leading practitioner of weight-reduction surgery said that the Wernicke’s encephalopathy is at most a rare complication.

“We have not seen this in any of our patients, and it’s seen in very, very few [cases]; I think it’s overrated,” said Scott A. Shikora, M.D., a bariatric surgeon at Tufts-New England Medical Center in Boston.

“It’s seen in the setting of intractable vomiting over a period of time, where the patient actually develops a thiamine deficiency, and the teaching in most of our courses and programs is that if you have a patient who comes to the emergency room with intractable vomiting, think of giving them thiamine,” Dr. Shikora said. “Usually that’s the solution.”

The classic triad of Wernicke’s encephalopathy — confusion, ataxia, and nystagmus — was present in more than half of the patients in the review. But in acute care settings, only about 20% of patients with the condition presented with all three signs, commented neurologist Michael DeGeorgia, M.D., of the Cleveland Clinic, in an interview. Dr. DeGeorgia was not involved in the bariatric surgery research.

“The tragedy of this disease is that it can be very serious, and you can even die from this,” said Dr. DeGeorgia. “But if it’s caught early it can be completely cured. The trick is to recognize it, and what has happened in the past is that people have failed to recognize it, because it’s associated with alcoholism. It’s under recognized in post-gastrectomy patients, or cancer patients, or anybody who is malnourished.”

In their review, Dr. Singh and Dr. Kumar performed a systematic review of medical and scientific databases looking for case reports, case series, or cohort studies of Wernicke’s encephalopathy occurring after bariatric surgery.

They identified 32 cases, 27 in women and five in men, a sex distribution that closely matches the female-to-male ratio for patients who undergo bariatric surgery, the authors noted. The patients ranged in age from 23 to 55 years.

The cases occurred from two weeks to 18 months after the procedure, most occurring from four to 12 weeks after surgery. The procedures included vertical banded gastroplasty, Roux-en-Y gastric bypass, elective gastric partitioning, and gastric plication.

A majority of the patients (25 of the 32) had vomiting as a risk factor, and 21 had the classic Wernicke’s triad of confusion, ataxia, and nystagmus. Other symptoms seen in these patients included optic neuropathy, papilledema, deafness, seizures, asterixis (bilateral) flapping tremor of the hands and wrist, weakness, and sensory and motor neuropathies.

MRI scans of the brains of these patients commonly revealed hyperintense signals in the dorsal medial thalamic nucleus periaqueductal gray area, third and fourth ventricles, and caudate nucleus and putamen. Fifteen of the patients, however, had normal radiographic findings (CT or MRI).

Serum thiamine levels were measured in six patients, and were low in four, and normal in two.

“Among patients who underwent endoscopy, findings included gastric outlet obstruction, stenosis, esophagitis, jejunal erosions, and stromal adhesions, as well as no abnormalities in a few cases,” the authors wrote.

Most of the reports did not include information about whether patients took thiamine supplements. A few of the patients developed Wernicke’s encephalopathy despite taking thiamine supplements.

Most of the patients made a full recovery after receiving parenteral thiamine, although some had residual neurologic problems. The defects included Korsakoff psychosis, persistent amnestic state with antegrade amnesia and retrograde memory loss, memory problems, persistent ataxia, nystagmus, and neuropathy.

“Thiamine deficiency is a pretty much preventable problem by just thinking that the patient is thiamine deficient, and treating it,” Dr. Shikora said. “But like a lot of other things with gastric bypass, there’s a relatively low incidence of it, yet everybody thinks it happens all the time.”