There are now reports that a very few women who have had obesity surgery develop nerve and brain problems from low Thiamine (Vitamin B1) levels.LINK2

Those who have this surgery often are unable to eat full meals, and must be sure to take vitamins to make sure that they don’t develop vitamin deficiency. But, of course, if the people having the surgery were organized and able to eat a decent diet they probably never would have developed morbid obesity.

(Yes, I have a weight problem and am aware of Metabolic syndrome…but I also counsel patients who overeat).

The disturbing part of the report is that the doctors found 13 cases of Wernicke’s encephalopathy.

You see, Wernicke’s encephalopathy is the most severe symptom of low Vitamin B1. In mild cases, you can get nerve problems (numb or burning feet and hands), dizzyness, poor coordination, vomiting, and visual changes. The problem is that if your obese patient is a diabetic, you might think the numbness and visual changes are from the diabetes rather than vitamin deficiency.

And if 13 cases of encephalopathy have occured, then how many have mild vitamin deficiency? And if there is Thiamine deficiency, might one be low in other vitamins? In the “acute” stage, B vitamins aren’t stored for very long, so are people risking other vitamin deficiency diseases (beri beri, pellagra, and Vitamin B12 deficiency…all of which can cause brain damage, dizzyness, incoordination, numb and tingling fingers, skin rashes, etc.)

In the third world, vitamin B injections are common for “weakness”. Perhaps we should order our post opearative patients shots to prevent these problems.

Now, most docs know about Wernicke’s encephalopathy because we have to watch out for it in alcoholics. If a person comes into the emergency room with DT’s, and has been drinking heavily, often they are B1 deficient. If you give them the usual IV with glucose, there is a danger that the brain which lacks thiamine will get a jolt and the nerve cells will be damaged. So traditionally we give vitamins in the IV bottle, and a shot of Thiamine.

The last Wernicke’s case I saw was thirty years ago: an old lady named Sarah who was found dehydrated after a long history of tippling. She had been living on tea and bread in addition to her beer, and then got sick and wasn’t found for a couple days.

After we pulled her through, she developed the complication of the encephalopathy, which is Korsakoff’s psychosis, which is the inability to make new memories. But like most people with that problem, she could lie through her teeth and make up stories to fill in the missing data (confabulation). About the only thing she remembered about the present was her beer. She loved her beer, and her compassionate doctor, instead of filling her up with tranquillizers, ordered one beer a day to keep her happy. So in the nursing home, the nurses gave her a beer every day at 3 pm so they could supervise her drinking while they were giving the change of shift report.

Poor Sarah. Her memory of the past was perfect, but she had zilch memory of what happened to her after her hospitalization. Never could remember the name of her nurses, how to get from the room to the cafeteria, or what day it was…but every day at about 2:30, she would manange to find her way to the nurse’s station and ask: Is it time for my beer?

—————

Nancy Reyes is a retired physician living in the Philippines. Her webpage is Finest Kind Clinic and Fishmarket, and she posts medical essays on Hey Doc Xanga blog

Be Sociable, Share!