Bariatric Surgery and Vitamin B

One of the common concerns expressed by individuals who are considering bariatric surgery or who have recently undergone such a procedure is whether or not they will need periodic vitamin B shots to maintain good health. There is no easy answer to this question. The answer depends mainly on the type of surgical procedure performed. However, your pre-surgical nutritional status can also be a factor.

The more aggressive the surgical procedure, the more difficulty your body will have absorbing nutrients and the greater your need for supplementation and, in many cases, injections of B vitamins. In fact, any patient who has had weight loss surgery must carefully monitor the nutritional quality of their food intake and take specially formulated vitamin and mineral supplements for the rest of their life to be sure they are properly nourished.

Just because a person is very overweight does not mean they are well nourished. It’s quite possible to gain extreme amounts of weight by feasting on sweets, snacks, and fast foods while avoiding nutritious items like fruits, vegetables, grains, even meats. People seeking bariatric surgery need to report any past nutritional deficiencies, and the surgeon needs to make sure they have adequate stores of nutrients like iron because some deficiencies are not easy to reverse after surgery.

Except for B₁₂ which can be stored in significant quantities in muscle tissue, the body retains only limited amounts of water soluble vitamins. However, people have difficulty absorbing enough B12 after mal-absorptive procedures and after surgeries that affect the body’s ability to produce stomach acid. Deficiencies of these nutrients can occur quickly unless those individuals are able to consume and absorb a balanced diet.

The term water soluble vitamins refers to all of the B complex vitamins and vitamin C.

Natural B₁₂ is found in foods that come from animals like meat, fish, and eggs. It is released from foods by stomach acid. Once released, it attaches to a carrier molecule called an intrinsic factor. At that point, the lining of the intestine can absorb B₁₂. People who have had bariatric surgery are at risk of B₁₂ deficiency because they eat much less food than is typical, produce less stomach acid, and in some cases, no longer have the surface area of the intestine where B₁₂ would be absorbed. A B₁₂ deficiency occurs gradually and silently. It causes a condition called pernicious anemia, which affects red blood cells, nerve cells, and the production of new tissues.

According to large-scale follow up studies, 30% of people who have had bariatric surgery develop deficiencies of iron or B₁₂. Careful meal planning and oral supplements can help prevent these conditions. In some cases, people may be missing too much intestine to absorb B₁₂ and need B₁₂ injections to prevent pernicious anemia.

Wernicke’s Encephalopathy 

In March 2007, investigators from the University of Iowa and Wake Forest University reported that Wernicke’s encephalopathy -B₁ (thiamine) deficiency syndrome- had been identified in 32 bariatric surgery patients. With quick treatment in the form of B₁ injections, the condition resolves, but if it goes unrecognized, it can rapidly result in permanent brain damage. And even with quick treatment, many patients suffered from some degree of neural damage.

Wernicke’s encephalopathy has three classic symptoms: jerky, uncoordinated movement; uncontrollable eye movements; and mental confusion. However, these typical signs were not evident in many of the bariatric surgery patients who developed the condition. In contrast, unusual symptoms such as hearing loss, weakness, convulsions, and tingling or numbness in the arms and legs were noted in many of the bariatric surgery patients. The researchers also found the majority (25 out of 32) had experienced frequent vomiting. Some bariatric surgeons monitor thiamine levels in all of their patients and provide monthly thiamine injections. In such cases, no signs of Wernicke’s syndrome have emerged. In light of these findings, the authors of the study suggested all patients be given preventative injections of B₁.

If you have had or are considering having bariatric surgery, discuss all the health risks including nutrient deficiency syndromes with your surgeon, closely follow all dietary and supplementation advice, and contact your doctor immediately if you experience any changes in sensation or gait.