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Thiamine (Vitamin B1) Thiamine, also spelled thiamin, is a water-soluble vitamin found in such foods as yeast, cereal grains, legumes, peas, nuts, port, and beef. This vitamin is essential to a number of metabolic processes, especially in the processing of carbohydrates.

The normal minimal daily requirement of thiamine is 1.4 mg. This amount of vitamin is usually readily obtained from a normal diet. However after gastric bypass, especially in the early post op period, it may be difficult to eat enough food to get enough of the vitamin. There may also be problems with thiamine absorption in some patients. We therefore recommend a daily multivitamin that contains Thiamine and routine thiamine supplementation.

Childrens' or adult chewable vitamins are convenient during the first 6 weeks post op. We recommend that the patient take one chewable adult Centrum or chewable Bugs Bunny Complete vitamin twice a day for the first 6 weeks. For the next 6 weeks we still recommend taking the vitamins twice a day, but they may be swallowed or chewed. After the first three months we reduce the vitamin dose to one pill once a day. We also recommend thiamine 100 mg (swallowed) daily for the first three months. (Thiamine is water soluble and excessive thiamine is excreted by the kidneys. Thiamine toxicity has not been described in the medical literature.)

Thiamine deficiency Acute thiamine deficiency was originally recognized in patients who were having significant problems taking foods due to a tight pouch or an ulcer and in patients who failed to take multivitamins. When we became aware of the early symptoms, we started to measure blood thiamine levels more routinely. We began to find patients with mild nonspecific symptoms who were otherwise doing well. We therefore started to recommend routine supplementation early on and monitor blood levels later.

Acute thiamine deficiency appears as a nonspecific syndrome: headache, mental clouding, nausea, malaise, myalgias (muscle aches and pains). As it worsens the patient develops more severe mental changes including depression, amnesia, inability to learn, confabulation (making up stories unintentionally), and hallucinations. Additional neurological problems can appear. These include a wide unstable gait (walking pattern), and motor weakness. Finally some patients develop congestive heart failure and peripheral edema (swelling).

Treatment of thiamin deficiency Treatment of mild thiamin deficiency is simple oral supplementation. Treatment of severe acute thiamine deficiency is done by giving high doses of intravenous thiamine for several days. If the deficiency is recent complete recovery is expected. However if it is severe and chronic with marked mental and motor impairment, complete recovery occurs in only half of the patients. Thiamine deficiency is diagnosed by the history of frequent vomiting and the symptoms listed above. A blood test confirm the diagnosis, but treatment is never delayed because the test can take several days to process.

Monitoring thiamin levels We monitor thiamin levels by measuring whole blood thiamin at 6 weeks, 3 months, 6 months, and one year post op. For the long term, we recommend monitoring thiamin every 6 months. Careful monitoring is important because the onset of thiamin deficiency can be insidious and the effects can be serious and permanent.

Prevention of thiamine deficiency During the first three months after surgery we place all patients on B1 100 mg daily as well as on multivitamins. We have started routine supplementation because we have documented that quite a few patients develop mild to moderate deficiency symptoms early on. Later when patients can eat a broader variety of foods in greater quantity we recommend daily multivitamins and then monitor B1 levels in the blood.

Jeopardy answer: What is Beriberi

Jeopardy question: What is the archaic (old fashioned) name for Thiamine deficiency?

A spasmodic rigidity of the lower limbs, etc.; an acute disease occurring in India, and commonly considered the same as Barbiers, - but the latter is a chronic disease. The word beriberi is, in all probability, derived from the reduplication of the Hindu word beri, signifying irons or fetters fastened to the legs of criminals, elephants, etc. A person afflicted with this disease is literally :fettered." [Thomas1875]

An acute disease occurring in India, characterized by multiple inflammatory changes in the nerves, producing great muscular debility, a painful rigidity of the limbs, and cachexy. [Webster1913]

A disease caused by a deficiency of thiamine, endemic in eastern and southern Asia and characterized by neurological symptoms, cardiovascular abnormalities, and edema. [Heritage].

From Ruby's list of archaic medical terms:


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