Globe and Mail - Tues March 13th, 2007

There's a downside to obesity surgery

SHERYL UBELACKER

Canadian Press

TORONTO — When people with obesity have surgery to help them lose weight, they can also lose something else — the ability to properly absorb certain nutrients, in particular Vitamin B1. And that deficiency can potentially lead to permanent brain damage if left untreated, researchers say.

In a review of the medical literature, researchers at the Wake Forest University School of Medicine found 32 cases of bariatric surgery patients who developed symptoms of Wernicke encephalopathy, a condition marked by memory loss and confusion, an inability to co-ordinate movements and rapid eye movement.

Wernicke's is caused by a deficiency in vitamin B1, also called thiamine, and these classic symptoms are usually seen in alcoholics, said lead author Dr. Sonal Singh, an internal medicine specialist at Wake Forest University in Winston-Salem, N.C.

“But interesting to our study, we found that these people also had other symptoms, like hearing loss, convulsions and tingling and numbness of the arms and legs — symptoms that have not been previously described with Wernicke's,” Dr. Singh said in an interview.

That made the researchers wonder if these bariatric surgery patients were suffering from more than just a B1 deficiency and may have been experiencing a deficit of other critical nutrients or had developed immunological problems.

Strangely, almost half of the patients with the neurological symptoms showed no brain lesions when given an MRI scan, said Dr. Singh, whose study is published Tuesday in the journal Neurology.

Of the 32 patients — who had one of four weight-loss surgeries, including gastric bypass and gastric banding — 13 made a full recovery. Eighteen others were left with various levels of dysfunction and one patient, a 33-year-old woman, died.

Most had experienced vomiting prior to onset of the neurological symptoms, said Dr. Singh, noting that patients ranged in age from 23 to 55, and 27 of the 32 were women. (In the United States, 75 per cent of bariatric surgery patients are women, he said.)

The vomiting could have been caused by any of several factors, including the anatomical changes created by the surgery; blockages caused by swelling around the surgical area; and ulcerations or other erosions of the stomach developed following the operation.

“When people who have had weight-loss surgery start experiencing any of these symptoms, they need to see a doctor right away,” stressed Dr. Singh.

“Doctors should consider vitamin B1 deficiency and Wernicke encephalopathy when they see patients with these types of neurological complications after weight-loss surgery. If treated promptly, the outlook is usually good.”

The average point at which patients began exhibiting Wernicke's symptoms was four to 12 weeks after surgery, although one patient developed problems two weeks after the operation and another 18 months later.

Dr. Singh said his study could not determine how common Wernicke's encephalopathy is among people who have surgery to help them lose weight, and he said studies that follow patients are needed to establish how often it occurs.

While some doctors prescribe thiamine supplementation after bariatric surgery as a matter of course, Dr. Singh believes national standards should be set for physicians to follow.

“This is an emerging risk which is going to become more important in the future as more people get surgery,” he said.

If you check the article out online at the globe check out the comments section. It's people like that that make me not tell people that I have had the surgery

Only a reporter who weighs 300 lbs, or has weighed 300 lbs should write a article on weight loss surgery, otherwise, blah, blah, blah.

I would be interesting if a study could have been done on what would happen to the same 32 people had they NOT got the surgery. Heart attack, stroke, diabetes.......???????

If this country is going to keep allowing companys to produce sugar-laced drinks, lunch-sized chocolate bars and chips disguised as childrens Snacks, 5 drive-thru's on every city block, vending machines in schools, commercials for crap food claiming it is PART of a complete meal, etc, etc......then they had better get use to the line-ups of people waiting for weight loss surgery. We can't have one without the other.

The rest of the world should shut-up if they don't know what it's like to to overweight, some metalbolisms can take it, most can't!!

Dr. Singh said his study could not determine how common Wernicke's encephalopathy is among people who have surgery to help them lose weight, and he said studies that follow patients are needed to establish how often it occurs.

I think that this is the important factor, and weighed against the benefits that this is to be considered a "side effect", just as the side efffects of not having the surgery include stroke, heart attack, diabetes and death.

I will take my chances here, but I think that it is good to be aware of.

So I am asking you all if you notice me becoming dumber please let me know. :biggrin1:

As for the comments from the people on the Globe site, it proves that not only smart people read the Globe & Mail.

Andrew

Only a reporter who weighs 300 lbs, or has weighed 300 lbs should write a article on weight loss surgery, otherwise, blah, blah, blah.

I would be interesting if a study could have been done on what would happen to the same 32 people had they NOT got the surgery. Heart attack, stroke, diabetes.......???????

If this country is going to keep allowing companys to produce sugar-laced drinks, lunch-sized chocolate bars and chips disguised as childrens Snacks, 5 drive-thru's on every city block, vending machines in schools, commercials for crap food claiming it is PART of a complete meal, etc, etc......then they had better get use to the line-ups of people waiting for weight loss surgery. We can't have one without the other.

The rest of the world should shut-up if they don't know what it's like to to overweight, some metalbolisms can take it, most can't!!

Well put Cloe. What concerns me is that we are going the way of the States where High Fructose corn Syrup is a new food group. That stuff is the devil, and should be banned quicker than trans-fat becasue I think it is doing way more harm.

Andrew

isnt this more for patients with RNY or other treatments that cut their intestins?

Nope this article is not just for RNY patients. The article does mention the lap band patients as well in this new study.

I saw that today too Dame J and I also read the comments on the G&M....yup....EXACTLY why I keep it to myself. The comments were very insensitive.