Weight-Loss Surgery Caution: Take Your Vitamins

[kebaldwin]

Weight-Loss Surgery Caution: Take Your Vitamins

By Kathleen Doheny
HealthDay Reporter
Mon Mar 12, 11:46 PM ET

MONDAY, March 12 (HealthDay News) -- Obese patients who undergo weight-loss surgeries such as gastric bypass can develop a rare but serious brain condition linked to vitamin deficiency, a new study warns.

Taking the recommended dose of supplements after surgery can prevent the brain illness, called Wernicke encephalopathy, which is caused by a deficiency of thiamine, a B vitamin.

The syndrome is "a problem everyone needs to be aware of," said Dr. Neil Hutcher, immediate past president of the American Society for Bariatric Surgery and director of the bariatric surgical service at Bon Secours St. Mary's Hospital in Richmond, Va.

Hutcher was not involved in the study, which is published in the March 13 issue of Neurology.

Wernicke encephalopathy can include vomiting, confusion, lack of coordination and visual changes such as nystagmus, an involuntary eye movement that can limit vision.

Doctors who perform weight-loss surgeries have known for years about this post-op complication, said study author Dr. Sonal Singh, an instructor in internal medicine at Wake Forest University School of Medicine, in Winston-Salem, N.C.

Singh is an internist and does not perform the gastric bypass surgeries. But he got interested in studying Wernicke encephalopathy after he treated a case a few years ago and then began noticing other patients with the problem.

"Absorption of vitamins is decreased after most gastric bypass surgery, so supplements are prescribed to make sure they get enough," Singh said. Still, some patients may fail to take the supplements as prescribed, boosting risks for low thiamine and Wernicke encephalopathy.

Taking a closer look at the issue, Singh and co-researcher Dr. Abhay Kumar of the University of Iowa combed the medical literature and uncovered 32 cases of Wernicke encephalopathy after obesity surgery.

The 32 patients had various types of obesity surgery, but the most common type was Roux-en-Y gastric bypass, in which some of the stomach and small intestine is bypassed.

Singh found that most instances of Wernicke encephalopathy occurred from 4 to 12 weeks after the surgery, and that one case came on 18 months later. Most of the patients, 27, were women.

When the researchers evaluated the cases, they found some patterns. The complication "usually occurs in younger women, under age 55," Singh said. "It usually occurs between one to three months after surgery."

"Vomiting is a risk factor,'' he said. "If you [frequently] vomit, you are more likely to get it."

Of the 32 patients, 13 made full recoveries after treatment with vitamin B1, but others continued to have problems. One patient died while hospitalized from septic shock, Singh wrote.

"Some got the problem despite taking the supplement," he said. But, in many of the cases, the patients were not taking the supplements as prescribed.

One thing is clear: Wernicke encephalopathy affects only a very small proportion of the 170,000 people who undergo obesity surgery in the United States each year, Singh said.

Still, because the condition can be permanent and is preventable and treatable, it's important for physicians and patients to be aware of it, Singh said.

Hutcher agreed that the risk to any one patient is small. Wernicke encephalopathy is "not at epidemic proportions," he said, noting that 32 patients with the syndrome were identified "out of hundreds of thousands of bariatric surgeries." Hutcher estimated that, overall, there must be "close to a half million bariatric surgery patients in the U.S."

For patients who have undergone the surgery or plan to, Singh has this advice: "After the surgery, make sure you take your vitamin supplements, including the thiamine, and if you have vomiting or other symptoms [such as confusion, lack of coordination, visual changes], seek help immediately."

While potentially serious when it does occur, Wernicke encephalopathy is "totally preventable and either completely or partially reversible," Hutcher said.

Reputable physicians who do bariatric surgery will emphasize that supplements are crucial after surgery, he added.

More information

To learn more about gastric bypass, visit the American Society for Bariatric Surgery.

http://news.yahoo.com/s/hsn/20070313/hl_hsn/weightlosssurgerycautiontakeyourvitamins&printer=1;_ylt=AidRK8.Ok69nEDYeTDYOpr.9j7AB

[kebaldwin]

I thought the "health experts" had proved that vitamin and mineral supplements do no good, are a waste of money, and could be dangerous!

[kebaldwin]

Neurological condition linked to obesity surgery

By Will Dunham
Mon Mar 12, 4:39 PM ET



Some obese people who have weight-loss surgery, particularly younger women, develop a neurological condition most often seen in severe alcoholics and linked to a vitamin deficiency, researchers said on Monday.

A study in the journal Neurology described the cases of 27 women and five men who developed the condition, Wernicke encephalopathy, after bariatric surgery.

Nearly all had experienced frequent vomiting in the weeks after surgery. Two patients died.

Wernicke encephalopathy can develop when the body does not get enough vitamin B1, also known as thiamine. It affects the brain and nervous system, with symptoms including double vision, eye movement abnormalities, unsteady walking, memory loss and hallucinations.

Lead researcher Dr. Sonal Singh of Wake Forest University School of Medicine in Winston-Salem, North Carolina, said it was unclear how common the condition was in people who have had surgery for obesity.

The researchers said they think it appears in people who have the surgery if they stop taking vitamin supplements or when they vomit so often that it prevents vitamin absorption.

Singh said, when recognized quickly, the condition can be treated easily with injections of thiamine.

People who have the surgery and their doctors should watch for signs of the condition in the first few weeks after the operation, Singh said.

Obesity is a growing problem in the United States and other rich countries, and the popularity of weight-loss surgery has been increasing steadily.

About 170,000 people had the procedure in the United States in 2005, a tenfold rise from the early 1990s. A study last week found that use of the surgery tripled among U.S. adolescents from 2000 to 2003.

"THIS IS A RISK"

"We're not saying to people 'Don't get the surgery.' But I think this is a risk that has to be considered now in the equation when people are deciding," Singh said.

Wernicke encephalopathy is usually associated with severe alcoholism or chronic malnutrition.

Singh and co-author Dr. Abhay Kumar of the University of Iowa combed through scientific literature for reported cases of the condition in people after bariatric surgery to figure out its timing, risk factors and symptoms.

They said it appeared most frequently one to three months after surgery, especially in young women, but developed as late as 18 months after surgery in one person.

The study found the condition can appear after all types of weight-loss surgery, including gastric bypass in which surgeons section off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions.

Other types include surgery to "band" the stomach and gastric partitioning that divides the stomach into two parts.

Thirteen of the 32 people recovered fully. Some of the 32 experienced symptoms not typical of the condition, including seizures, hearing loss, psychosis, muscle weakness and pain or numbness in the extremities, the study found.

"It's really too early to say how common or how rare it is. I think it is more common than people expect," Singh said.

While most of the cases involved women, Singh said it was too soon to say whether women were more susceptible or only appeared to be because about three quarters of weight-loss surgery patients are women.

http://news.yahoo.com/s/nm/20070312/hl_nm/obesity_surgery_dc&printer=1;_ylt=Ai5DyjvSGYqzeGjHQjRVDLUR.3QA