Monday, August 6, 2007

Vitamin B---B1---Thiamine

I'm going to take a break from the Fat Soluble Vitamins series to discuss Thiamine. This is serious deficiency noted after WLS. It has some dire consequences if not addressed quickly.

Thiamine Deficiency May Complicate Gastric Bypass

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."

Bariatric surgery is an effective treatment for many patients with morbid obesity, but this procedure has attendant risks. Neurologic complications are particularly serious potential complications of bariatric surgery, including myelopathy and ataxia associated with deficiencies in vitamin B12, vitamin E, and copper. Patients might also experience neuropathies related to other deprivation of essential vitamins and micronutrients.

The classic presentation of Wernicke encephalopathy includes oculomotor abnormalities, mental status changes, and ataxia. Unfortunately, this classic presentation occurs in only 20% of cases of Wernicke encephalopathy. Examining risk factors for thiamine deficiency, including bariatric surgery, can help physicians diagnose this disorder.

Obesity Surgery Linked to Atypical Encephalopathy

Bariatric surgery appears to increase the risk for atypical Wernicke encephalopathy, a serious neurologic condition caused by thiamine deficiency that is typically associated with alcoholism.

In the first study to characterize the syndrome in this patient group, researchers at Wake Forest University School of Medicine in Winston-Salem, North Carolina, conducted a systematic literature review in an attempt to describe the clinical features, risk factors, radiographic findings, and prognosis of Wernicke encephalopathy.

"What we found in our paper, which is clinically useful, is that this syndrome is most commonly reported in young women who present with vomiting 1 to 3 months — although it can range from 2 weeks to 18 months — following obesity surgery," principal investigator Sonal Singh, MD, told Medscape.

Currently, said Dr. Singh, there is no standardized pre- or postoperative protocol aimed at preventing Wernicke encephalopathy; it is left up to the individual providers to determine treatment.

Although some research suggests preoperative thiamine supplementation provides effective prophylaxis, more research is required to confirm that this is the case.

The good news is that if caught in the early stages, the syndrome is very responsive to thiamine treatment given intravenously or by injection. The study showed that 13 of the 32 patients made a full recovery; others had some residual neurological deficits.

In the meantime, said Dr. Singh, clinicians should have a high index of suspicion for Wernicke encephalopathy in patients who present with any type of neurological symptoms after bariatric surgery.

"It is important that doctors and patients are aware that the outcome is wholly dependent on early diagnosis. Patients should be advised to immediately report any neurological symptoms," he said.

In the meantime, a prospective long-term study to determine the incidence of the syndrome is needed to help guide preventive, as well as treatment, protocols.

As you can clearly see, this can be very dangerous. We're talking about your brain here people. The scariest part about this to me is the fact that those having WLS do not have the typical types of symptoms associated with encephalopathy. Also it is pretty scary too that not everyone is aware of the nutritional deficits that are so common after WLS. I don't mean just US either. Many docs aren't aware either.

That's why I preach proactive health care. You must take an active part in your own care. You must seek out knowledge to make you a better health consumer. If there is one thing I've found out over the years, you can not blindly listen to your doc. Quite a few just do not keep up to date on the research available. If they did, tons more people would be on a low carb eating plan by now. (Hey had to throw that in there too.)

So okay, now we see what the potential problems may be. Let's cover some basics about Thiamine now.

Thiamine is a water-soluble B vitamin, previously known as vitamin B1 or aneurine. Isolated and characterized in the 1930s, thiamin was one of the first organic compounds to be recognized as a vitamin. Thiamine occurs in the human body as free thiamin and as various phosphorylated forms: thiamin monophosphate (TMP), thiamin triphosphate (TTP), and thiamin pyrophosphate (TPP), which is also known as thiamin diphosphate.

So being water soluble means as post WLS patients, we are able to absorb it more readily. So that brings to the equation, if we absorb it better, then why do we suffer with a deficiency? Let's first look at what the RDA of thiamine is. Then we'll see what foods are high in it.

Recommended Dietary Allowance (RDA) for Thiamin
Life Stage Age Males (mg/day) Females (mg/day)
Infants 0-6 months 0.2 (AI) 0.2 (AI)
Infants 7-12 months 0.3 (AI) 0.3 (AI)
Children 1-3 years 0.5 0.5
Children 4-8 years 0.6 0.6
Children 9-13 years 0.9 0.9
Adolescents 14-18 years 1.2 1.0
Adults 19 years and older 1.2 1.1
Pregnancy all ages - 1.4
Breastfeeding all ages - 1.4

So for me that means I need only have 1.1 mg of thiamine daily. But look at this chart to see where we can get thiamine from our diet alone.

Food Serving Thiamin (mg)
Lentils (cooked) 1/2 cup 0.17
Peas (cooked) 1/2 cup 0.21
Long grain brown rice (cooked) 1 cup 0.19
Long grain white rice, enriched (cooked) 1 cup 0.26
Long grain white rice, unenriched (cooked) 1 cup 0.04
Whole wheat bread 1 slice 0.10
White bread, enriched 1 slice 0.11
Fortified breakfast cereal 1 cup 0.5-2.0
Wheat germ breakfast cereal 1 cup 4.47
Pork, lean (cooked) 3 ounces* 0.72
Brazil nuts 1 ounce 0.18
Pecans 1 ounce 0.19
Spinach (cooked) 1/2 cup 0.09
Orange 1 fruit 0.10
Cantaloupe 1/2 fruit 0.11
Milk 1 cup 0.10
Egg (cooked) 1 large 0.03

*3 ounces of meat is a serving about the size of a deck of cards

For me and my low carb lifestyle---this list has pretty slim pickin's. Since the deficiency really shows up in the early stages after WLS---you can plainly see how you can become deficient. Throw in the problem most new preops experience of not eating very much period and the problem only gets worse. The only food on that list that I ate as a newbie was eggs. It would take you eating 36 eggs a day to get the recommended amount of thiamine. I eat alot of eggs, but I would take nearly a month to eat 36.

So the answer is simple---take a good B Complex---making sure it has thiamine in it---not all of them do I've found. Poof. No more deficiency.

Thiamine is a great vitamin for the brain as you can well see, but it plays a role in other diseases also, Cataracts, Alzheimer's disease, Congestive heart failure (CHF), and Cancer. So rather than turn to big pharma, take care of your health from a nutritional standpoint. It just makes common sense.

Update: 8/9/07

This news story just came out concerning diabetes and thiamine deficiency.

Vitamin B1 deficiency found in diabetics

British researchers have discovered that deficiency of Vitamin B1 may be key to a range of vascular problems for people with diabetes.

Paul Thornalley, of the University of Warwick Medical School, said he has showed conclusively that diabetic patients are Vitamin B1, or thiamine, deficient in blood plasma.

The study, published in Diabetologia, found that thiamine concentration in blood plasma was decreased 76 percent in type 1 diabetic patients and 75 percent in type 2 diabetic patients.

The researchers found that the decreased plasma thiamine concentration was not due to a deficiency of dietary input of thiamine, but due to a profound increased rate of removal of thiamine from the blood into the urine.

The researchers also found that the decreased availability of thiamine in vascular cells in diabetes was linked diabetic complications such as damage to the kidney, retina and nerves in arms and legs. It likely reflects problems in endothelial cells -- cells that line the body's entire circulatory system -- and increased risk of atherosclerosis -- chronic inflammation in the artery walls.

WOW!! A whopping 75% deficiency in type 2 diabetes alone. Since many people who undergo WLS have a history of diabetes, I felt compelled to add this in. For those of you who are still diabetic, even after WLS, please take heed and increase you B1 supplementation. Also, do not forget to make sure your doc is checking your thiamine levels.