To learn more about the importance of Vitamin B1 after gastric bypass & sleeve, check out our audio transcript.

The Importance of Vitamin B1 after Gastric Bypass & Sleeve

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxall, Registered Dietitian. Today we are going to dive into the topic of vitamin B1, the importance of vitamin B1 after gastric bypass and sleeve. And we are going to kind of get to the minute details of why it matters after you’ve had bariatric surgery and how it impacts really a big piece of your health after weight loss surgery. So a lot of people are familiar with vitamin B12, but not a lot on vitamin B1. And I’ll say while doing bariatric surgery or being involved in bariatric surgery since 1995 in some way, shape or form, it has been an interesting experience. And I will say way before the surgeons I worked with were doing ruin y gastric bypass, we were not doing that. We were already seeing vitamin deficiencies without even bypassing the part of your intestines where you absorb nutrients, where you absorb all the vitamins and minerals.

Early Recognition of Vitamin B1 Deficiency

(01:29):

So we were already seen those come to life and already was addressing this piece way back in the mid to late nineties and making sure that our patients were receiving adequate vitamin B1 and a huge difference when we implemented this and just making sure that you get an adequate amount and we were really aggressive, probably too aggressive with the milligram dosage, but it did make a huge difference when we did implement that. So let’s get into the basics. The foundation of vitamin B1, vitamin B1, it’s also called thiamine. Some people call it thiamine. So however you have heard it, vitamin B1 is thiamine and it is one of the B vitamins in the complex family and it is involved in converting food into energy. So it is playing a role in just like vitamin B 12 in how well you feel energized.

The Role of Vitamin B1 (Thiamine)

(02:49):

It plays a role just not as significant in the energy category, maybe as much as vitamin B 12, but it performs a lot of functions in your body. So it plays a role in your metabolism, your nerve function, your brain health, and like all B vitamins, it is water-soluble and it has to be replenished through your diet or supplements. So your body does not make this vitamin. You have to be diligent about getting, and I’m going to go through some areas that can rob your vitamin B1. So maybe you are even consuming adequate amounts of vitamin B1 in your diet and in your multivitamin, or maybe you’re even taking a B-vitamin or B complex, you’re like, I’m good, I’ve got adequate amounts, I’m hitting the numbers that it has been recommended, but yet you have some symptoms. You can identify some of these symptoms that are showing you have a deficiency.

Factors Affecting Vitamin B1 Absorption

(03:56):

So this is where testing is so important in making sure that you are getting and absorbing what your body is actually needing. This is where working with your bariatric team, working with a skilled practitioner who understands the interpretation and the actual lab to order. If your bariatric team should be drawing a whole blood thiamine and it should not say vitamin B1, it would say whole blood thiamine. So make sure that they are testing the right one. And even I know there are some really great family doctors and who are super open to managing the nutrition piece after weight loss surgery and that’s amazing, but not all of them are, and some of them just don’t have the experience, so they may not understand the interpretation of how to look at it. So again, making sure that the right blood test is drawn will give you a better picture of your true status of your actual B1.

(05:13):

So keep in mind, having gastric bypass or sleeve surgery does just put you at a higher risk. We are altering your anatomy, we are altering your ability to digest and absorb nutrition. So this matters. This makes a difference on the outcome of what is available for your body to use. And I know that you may be thinking, okay, how would a sleeve, how would that impact? And with a sleeve, you have to think about the lower amount of stomach acid that you would be having. That in essence really impacts the big picture of how it’s actually available to absorb. So because you’re not without adequate stomach acid, you’re not going to be able to break down the food to appropriate molecules and to be delivered appropriately, if that makes sense. So again, staying on top of this actual level and testing your blood annually as a bariatric patient is key.

Vitamin B1’s Role in Energy Production

(06:26):

So vitamin B1, it plays a central role in the production of your mitochondrial ATP, which is kind of the powerhouse. The mitochondria are the powerhouse of energy. So you want this little piece. All of these vitamins and minerals, micronutrients and phytochemicals have a role and without them your body will be lacking and they are learning more and more about the mitochondria and how important it truly is. And in a lot of chronic disease states, the mitochondria have been impacted. So we know that vitamin B1 plays a role in the production of mitochondrial ATP, which is your energy, and this is why you want to make sure you are getting optimal amounts. It is also essential in rate limiting co-factor in many processes, particularly at the entry points of the glucose fatty acid and amino acid pathways. So it’s impacting fats or carbohydrates, fats and proteins.

Impact on Nutrient Absorption:

(07:42):

So all of these are energy, the food, the energy from our food sources are going to be impacted because B1 plays a role in this process. So it plays a role in fueling the body by converting the food into energy and then also maintaining your proper nervous system function and generating DNA and RNA gastric bypass and gastric sleeve patients because of your anatomy being altered. Again, this is impacting nutrient absorption. This is where you have to be diligent about intake and monitoring. So those are the two pieces. Doing your part with the food, doing your part with the supplements, and then doing your part with getting those annual blood draws. That’s the biggest thing for prevention and protection. So that’s how you prevent problems that I’m about to cover. The consequences, the risks, the symptoms, all those things that come with having a vitamin B1 because of bariatric surgery.

ASMBS Guidelines and the Emphasis on Vitamin B1

(08:59):

Now I will say probably 20, the 2016 or 2019 A-S-M-B-S guidelines for nutrition. I can’t remember which year it was that they came out and it was like someone had dug into the B1 thiam and the whole document was just massive on the amount of information on vitamin B1 thiamine. It was a huge difference from the previous guidelines and it really made an impact in how programs were addressing this. And I know that if we have a patient that is coming in with dehydration and they just need IV fluids, they would get a banana bag and it has B1 thiamin in it. So that is something that’s super important to make sure when you’re rehydrating that you are getting the vitamin B1 as well. But again, this is where it began to be questioned. Are bariatric patients getting enough? And it was in that timeframe when the AS SMBS guidelines for nutrition came out.

Importance of Continuous Monitoring

(10:24):

Again, I don’t remember the exact year, I want to say 2016 was maybe the first time that it really blew up and made a significant impact on the document, on how they were reporting about it. Prior to that, it had very little recognition and in all honesty, it was very interesting. At the center that I worked at, it was already a priority to us. We were already utilizing high doses of this on all of our patients. Didn’t matter which surgery you had because interestingly enough, so we did lap bands and so the adjustable bands were done, we phased those out. We didn’t see the success with them, but we did see B1 thiamine deficiencies with even the adjustable band. So again, if you’ve had a band or history of having a band and then maybe you’ve had some revisions from that, making sure that you are still monitoring and getting adequate intake is super important.

The Emergence of Vitamin B1 Awareness

(11:36):

So again, B1, it turned the corner and kind of exploded in the bariatric world, it seemed 2016, 2019, don’t quote me on the year, but I do remember all of the dieticians in the office. We were like, wow, what happened with B1 Thim and why are they all just now coming to this conclusion? How important it’s, and we’re like, we’ve been used to this for 15, 20 years already. So it was just interesting. It was interesting. But nevertheless, several studies have shown that post-surgery patients are at risk for thiamine deficiency despite supplementation. So again, like I said earlier, just because you take a supplement does not guarantee that your body is capable of utilizing all of that. Some individuals may need additional support, which is one that I would say probably is not as familiar in the conventional world. So I would tend to, if I have somebody who’s really struggling with their vitamin B1, we just try an over the counter thiamine and it really doesn’t go anywhere.

Thiamine Deficiency Risk Despite Supplementation

(12:55):

I would be recommending the Benfotiamine and this is a fat soluble form of thiamine and it is going to be better absorbed than the water soluble. But I’ll get into more details of that in a little bit. I have some studies on that as well. But in order to maintain optimal vitamin B1 patients and their bariatric team should recognize the importance of the symptoms and what can help maintain an optimal level. I would love to say that we could give a dose for every single person, which honestly is what we would do. Everyone had the same dose, but we would adjust it, or at least I did as a dietician when I would be evaluating blood work, I’d be like, okay, this person’s B1 is high, there’s no need to be at this a hundred milligrams, we need to drop it, so let’s drop it down to 50 or 25.

Personalized Vitamin B1 Maintenance

(13:52):

Let’s go a little lower because they obviously are getting more in their diet and absorbing it well. So optimizing that and personalizing it is what I would say. So making sure that you are being guided by that lab draw. And I will say this is a plug of getting your annual labs drawn, and I would say this is probably the hardest thing for bariatric patients is continuing that care, that level of care that you truly need because your anatomy is no longer the same and it’s permanent for life. So you’ll always need these annual labs drawn nutrition labs that no family doctor is routinely checking. So at most I have seen B 12 and vitamin D on more primary

Vitamin B1 Deficiency Symptoms

(14:50):

Care doctor lab draws, which is awesome because they have really solid standing with people. But for a bariatric patient, that list grows. So your nutrition indicators grow. You have a whole list of vitamins that should be checked because bariatric surgery is in the business of malnutrition. So we are altering how you absorb nutrition. So this is why I’m putting that plug in for making sure that you get those annual labs drawn. Don’t skip it, don’t wait five years or don’t get it your first year and then never again invest in yourself because these foundational things, so whether you realize it or not, vitamins and minerals, phytonutrients, polyphenols, antioxidants, all of these things is what protects us from diseases. And if we are not absorbing well because of bariatric surgery, then you are at risk for more chronic diseases. So it’s just another little push schedule that appointment, get those labs drawn, and you will have the ability to keep yourself in a prevention mode, keep yourself out of the doctor and out of the hospital more.

The Importance of Preventive Care

(16:15):

So let’s talk about vitamin B1 deficiency symptoms. What would someone experience if they are having an actual vitamin B1 deficiency? So one is fatigue and weakness. Vitamin B1 can lead to fatigue like we talked about your mitochondrial ATP. So this is your powerhouse of energy. This is where all of your energy is derived from. So if you feel tired and weak all the time, then again, if you haven’t had your whole blood thiamine drawn, this is where you need to make sure you’re checking them. Number two is nerve damage. So this one gets confusing for bariatric patients who also have diabetes. So a lot of those patients will say, oh, I have some nerve damage from my diabetes, which may be very true, but if I have someone who wasn’t experiencing it and now they are experiencing it after bariatric surgery, I am going to make sure that that whole blood thiamine is within optimal ranges and making sure we’re covering all the bases to make sure that hey, thiamine is not the problem here.

Nerve Damage and Thiamine Deficiency

(17:36):

So that’s in essence really though, and you’ll see in a minute that B1 thiamine actually plays a role in glucose metabolism. It does impact your blood sugar and helping it perform optimally. So if you have some nerve damage, these are things like numbness, tingling, even pain, so particularly on your hands and your feet, but this is where you have to kind of know how you’re doing with your diabetes. If you’ve been diagnosed with diabetes, you always have diabetes, but it’s either in remission or not. So staying on top of this lab indicator is a good thing. So even if you’re at your primary care doctor and he’s managing your diabetes, maybe you have or haven’t been to your bariatric team and getting those annual labs drawn, you could ask if you’re having some nerve pain or tingling or numbness, those types of things.

Memory, Concentration, and Brain Fog

(18:38):

Ask your primary doctor to check a whole blood thiamine just to make sure that your bases are covered. Number three is memory and cognition. So vitamin B1 deficiency can cause memory problems, poor concentration and brain fog. So this mental health piece is important. And I will say it does get confusing again here because the majority of bariatric patients are females between the forties and sixties, and guess what? Forties and sixties is perimenopause and menopause. So guess what? You have more memory problems, poor concentration and brain fog. Then you throw in the group of people who come into bariatric surgery with hypothyroidism or Hashimoto’s where they have issues already with their thyroid functioning appropriately. Again, checking these levels, making sure that you’re checking those boxes that nope, this isn’t the issue. So if you’ve really noticed that, hey, my memory, my concentration, just a foggy brain more chronically, then ask your doctor to check a whole blood thiamine and just say, let’s check this box off and make sure that it is at optimal levels.

Gastrointestinal Disorders and Thiamine

(20:13):

Because I’ve had bariatric surgery, I mean to me that should be a no-brainer. Number four is gastrointestinal disorders. This one is very interesting. So we will find that individuals who have a lot of GI distress is very common to have thiam and deficiency. So we do know that GI issues do come with bariatric surgery, constipation, diarrhea, bloating, gas, all of those things are very common and having GI problems is a symptom of a B1 deficiency number five is cardiovascular problems. Thiamin plays an integral part of cardiovascular health and having a deficiency in B1 thiamine can increase your heart rate cause shortness of breath and lead to heart complications. So if you are realizing that, hey, you know what, I’m going up this flight of steps and I do feel like I’m huffing and puffing a whole lot more. I’m walking to my car and it feels harder.

Cardiovascular Problems and Thiamine

(21:28):

Or maybe your doctor’s office is saying your heart rate is higher or you are noticing it physically, you can feel it again. Checking that whole blood thiamine is important. Number six is muscle wasting. So insufficient thiamine levels can cause muscle wasting in bariatric patients affecting their overall strength and health, and we know that your grip strength is an indicator of longevity. So if you have good grip strength and don’t quote me on any of the numbers and stuff like that for it, I would encourage you to read the book Outlive by Dr. Peter Atia and it’s a really good book. I listen to it on audible, so I go through it pretty quickly and at a faster speed is what I usually do, but he does talk about this. We know that sarcopenia is an issue as we age, we lose muscle and perimenopause and menopausal females lose more muscle rapidly, and this is where that muscle wasting or sarcopenia becomes a problem.

Muscle Wasting and Vitamin B1 Thiamine

(22:43):

B1 thiamine is involved in this process. So again, if you are a bariatric patient, and even if you’re not, I would say if you have family members or friends that are having issues with this and they haven’t ever tested their whole blood thim, it would be a good thing to evaluate or just actually just work with the dietician who could do that and make sure that they’re evaluating these levels appropriately. Number seven is psychological symptoms. So vitamin B1 deficiency can cause psychological symptoms like anxiety, depression and making it super difficult to manage your mood and your motivation be because of this side effect. So this is where if you do struggle with anxiety and depression and you’ve had bariatric surgery and maybe you’re a number years out from bariatric surgery and maybe your anxiety and depression has ramped up. Maybe usually I like to look at a timeline of events.

Psychological Symptoms and Thiamine Deficiency

(24:02):

So when I have my patients that are working with me, I have them fill out this long assessment form and it gives me that snapshot in time of when things started happening and it gives me that picture of saying, Hey, okay, anxiety and depression became a problem at this time or this season and this was six months prior to when all the problems started and now they’re working with me. So again, you just kind of back it up and say, okay, we need the full panel. We need to look at the big picture of what you are actually absorbing. So again, all of these things play off of each other because I could even say the same thing about perimenopause and menopause. You have more anxiety, more depression. So again, it’s getting with a practitioner who understands all of this and can look at that 30,000 foot view picture and say, Hey, okay, we have bariatric surgery so we know that these vitamins, minerals are going to an issue we have to pay attention to and start putting all of these pieces together.

Vitamin B1 Thiamine’s Role in Blood Sugar Regulation

(25:22):

So yes, do I want you to have relief if you’re having anxiety and depression? Absolutely, but does that mean you have to go on anxiety medication or an anti-depression and anti-depression medicine immediately? Maybe not. I mean maybe if we just get your micro minerals and all your vitamins and minerals kind of addressed and replenished that restores all of these problems and makes them go away. So again, you have to, again, working with someone who understands this really can help speed up the process and making sure that you are not missing any piece. Let’s look at the big picture of B1 thiam in’s role in your overall health. So we can think about blood sugar regulation. So thiamine plays a role in maintaining a stable blood sugar and how your body metabolizes carbohydrates and post-bariatric patients, especially those with diabetes or pre-diabetes, have to really pay attention to their vitamin B1 intake because this is going to impair because you’ve had bariatric surgery or you had diabetes.

Thiamines Link to Alzheimer’s and Other Diseases

(26:49):

This is going to impair your body’s ability to maintain a normal level. Next is Alzheimer’s disease. There is some evidence showing that thiamine might protect against neurodegenerative diseases like Alzheimer’s, and so it’s super important to make sure that your thiamine intake after bariatric surgery is monitored to make sure that you don’t dip low chronically because in the end it could impact your brain health. So the next one is Barry Berry. Barry Berry have totally seen this in the bariatric world, Barry Berry, and the next one is Warnick course, ofoff syndrome. So both of those have been seen at least where I have worked, I have seen this with patients and I would say the one thing that we were really good at all the dieticians that I worked with, we were really good at monitoring symptoms. So every visit that you would come in, we’d go through a list of symptoms of vitamin deficiency symptoms.

Symptoms and Tracking Vitamin B1 Deficiencies

(28:03):

So we are covering all of those things. We’re vitamin minerals, proteins, fats. We’re asking all these questions because we have that knowledge to know that hey, this symptom is a direct correlation to a low vitamin A or a low vitamin B1 or a low B 12, and then when we start getting multiple symptoms like two or three, a few of these symptoms listed, it really pulls it all together for me to show that, hey, this person has a high likelihood of saying, Hey, this vitamin could be low because they have all of these symptoms. So then that’s when I would order blood work and make sure that we are testing those vitamins or anything that correlates with those symptoms I would be addressing. Berry, berry is where it has progressed to a higher level deficiency. So your hands and feet are swelling, they tingle or have a burning sensation, you feel confused breathing problems due to lungs being filled with fluid and then uncontrolled eye movements.

Progression to Beri Beri

(29:24):

So your eyes will kind of go back and forth without you even knowing or doing it. So again, those are important things to ask yourself, am I experiencing these symptoms regularly? Not just occasionally, but regularly Are we seeing this occur? So that again, that’s usually when it’s progressed further, if you are staying connected with your bariatric team, again, this is another plug for getting those annual labs drawn, but they should be assessing you for this. These are the important pieces that we need to put with these levels. So for me personally, I’m going to ask you all of those questions about vitamin and mineral deficiencies, protein adequacy, and I am going to match that with your blood work. So when your labs come in, I’m going back to that last visit note and I’m looking, what symptoms do you have and what are these numbers telling me?

Personalizing Nutritional Care

(30:38):

I’m going to take those numbers and I’m going to say, are they in the normal reference range? Fix all the ones that are abnormal out of the normal reference range? Those are the obvious ones. Then the ones that are within the normal reference range but maybe are suboptimal. Maybe they’re low normal or high normal or just maybe not optimal for you. Yes, they are reference ranges and there is a range that we could all fall within, but we’re also different. It doesn’t mean that just because your body even needs higher or lower amounts of something that’s not wrong either. So as a practitioner, I should look at the data, but hear what you’re saying, listen to what you’re saying and assess on treating you appropriately providing the best care possible because again, we’re all different. So that doesn’t mean that the reference range that is established for the bariatric community, I mean, just think about that.

Timely Intervention and Prevention

(31:51):

You can have somebody that’s six five and someone that’s four 10, and we use the same parameters, guidelines, reference ranges for all of us doesn’t make sense. That’s where you have to have somebody personalizing it, putting these puzzle pieces together to actually make all this make sense. So if someone progressed to Barry Berry one, either the patient did not follow through on their end and get the blood work in that case or two, or maybe there were skipped appointments or just not adequately scheduled appointments or whatever, but not enough touch points that something was able to be seen, right? You weren’t seeing the right providers that could acknowledge this type of disorder because for me, I would’ve caught thiamine deficiency prior. If I have all the symptoms, if I’m checking these symptoms on every visit, then to me, I would’ve had some red flags if you would’ve said, Hey, my hands and feet are swelling, okay, we’re checking your whole blood thiamine, we’re checking your protein, the pre albumin, we’re going to check C-B-C, C-M-P, we’re going to check all of these indicators because not normal and because you can have a burning sensation with berry, berry, I’m also going to test copper and zinc because copper can give you a burning sensation in your feet too when it’s low.

Financial Considerations for Lab Testing

(33:33):

So again, all of these things can cross lines and give similar symptoms. That’s where you have to be educated in knowing the difference. So again, I would test all of those because of those symptoms, and this is where you have to take care of yourself. You have to advocate and say, I want these drawn. Yes, it’s an investment. I know labs are not always cheap and they are expensive at times, but there are options. I had a patient for a number of years, she would email me every year and she had no coverage for labs and to do our full panel out of pocket is like $2,000 and she’s like, I can’t afford that. So every year she would email me and say, I’m ready for my labs. And we would use a direct to consumer lab service and she would say, this is how much, this is my budget.

The Role of the Bariatric Team

(34:36):

I have $400 this year and this is all I can spend. So I would pick, we’d go through her symptoms, we would go through all the notes and kind of evaluate where she’s at with her body and how she’s feeling and taking everything. Has she been good at taking consistently? Has she missed a lot of doses of any one thing? And I would base that on what labs we drew that year, and some of ’em I drew every year. I wouldn’t slack. I would make sure that every year they’re drawn, but some of them, they were not done every year and we would just kind of alternate and maybe do them every other year, but really I just personalized it to her and what she truly needed. Now the next one is the warnick Korsakoff syndrome, and this is, again, we’re worsening, we’re getting worse.

Understanding Wernicke’s Disease and Alcoholism

(35:31):

We’re not addressing the issue. So this is why whenever you start having chronic problems, you need to get into your bariatric team because they need to address the nutrition piece that the other providers are not thinking about. That is not their wheelhouse, that is not how their brains work. They’re thinking other things. They’re thinking of all the other stuff and covering those bases. Your bariatric team is the one that is going to cover these, the malnutrition deficiencies that occur after bariatric surgery. Those are the things that your bariatric team is likely the one that would catch, not typically, I’m not going to say always, but you can go to a neurologist and that would be their wheelhouse. But again, for some people, your symptoms are so vague and not extreme that you can float through different appointments and it gets dismissed and it really turns into something bigger because you are able to tolerate so much more than maybe someone else that it really gets dismissed unintentionally.

Benefits of Cataract Prevention

(36:50):

And it’s not that they were trying to be dismissive, it’s just because that was not the forethoughts of where their brain goes for those types of symptoms. So this is the Wernikes Disease. It plays a role in your nerve endings and actually causes damage can cause something called foot drop. And the foot drop is where it’s kind of like curved, it curves, and when you walk, that is a sign of the wernikes disease. And again, also it’s having the jerky eye movements and just walking difficulties, breathing difficulties again because we’re damaging the nerves and your whole nervous system is being impacted. It’s definitely something that can be seen in the world of alcoholism. So if you truly have a bariatric patient who is also struggling with alcoholism, this could really be an issue. So this is where you have to make sure that getting your vitamin B1 in, if you have alcohol use disorder or you are consuming alcohol frequently, then that would be something to keep as a top priority.

Preventing Memory and Mood Problems

(38:20):

And then also the memory and mood problems that come with the corset cough syndrome and turning this around high doses of thiamine can improve that muscle coordination and that memory loss that can come from progressing to these more severe forms of vitamin B1 deficiency. Additionally, something that’s interesting is cataracts. So there’s several nutrients that can reduce the development of cataracts, and thiamine is one of them. So having a diet rich in vitamin A, B1, B two, B three and protein does reduce your risk of developing cataracts. And then additionally, getting enough vitamin C, E and B complex vitamins and even flic acid can prevent cataracts from developing. But they definitely know that more research is needed in this, but they do see benefits in those vitamins. So B1 included that can help in the prevention phase of cataracts. So what does the A-S-M-B-S guidelines say? How are we supposed to assess a bariatric patient for vitamin B1 deficiency? So here are kind of the parameters that are given.

Cataract Prevention with Nutrients

(39:53):

People that have a higher risk of vitamin B1 deficiency are females, black individuals, people who are skipping their checkups, so bariatric patients who are not doing those annual labs, any bariatric patient that is experiencing stomach or intestinal issues or just digestive problems or having severe nausea, vomiting, or even constipation, people with heart issues who take medications like furosemide, those with small intestinal bacterial overgrowth or sibo. So again, this is so common in bariatric patients to develop sibo, 40 to 80% of bariatric patients can develop sibo and guess what? It consumes those vitamin B1 and does not leave enough for you. And then also losing weight to rapidly or using alcohol, all of those would be red flags that, hey, you are in a higher risk category and we need to monitor this level consistently. So thiamine and supplementation. So how do you prevent it?

ASMBS Guidelines for Assessing Risk

(41:23):

How much should you be consuming? The A-S-M-B-S guidelines are 12 milligrams of thiamine a day, but preferably 50 to a hundred milligrams daily. And I will tell you in my experience, a hundred milligrams right out of the gate is great. So maybe the first three to six months use a hundred milligrams. We typically saw that B1 thiamine would be elevated when that dose was consistent and we were very comfortable and confident in dropping that to 25 to 50 grams. Honestly, we never fully relied on just the multivitamin. 12 milligrams never seemed to be sufficient, but 25, 35 to 50, that definitely was a better match for our patients. And it’s just that most multi bariatric multivitamins don’t contain, nor do regular multivitamins contain high doses of that typically. But if you are diagnosed with a deficiency, you are going to have to take a hundred milligrams, and typically you can do that two to three times a day until you start feeling better having, again, hydration with like if you’re getting IV fluids and they’re not including a banana bag that can deplete thiamine.

Thiamine Supplementation Recommendations

(42:54):

So making sure that they are doing a banana bag that has thiamine in it is important as well if it has progressed. So say someone is presenting and they are really, really low and they could do through a vein or through an IV where they replenish it more quickly and that’s going to be more in the 200 to 500 milligrams three times a day for three to five days, and then they’ll lower the dose and then they’ll do it for another three to five days. Again, we’re just rapidly increasing the body with these doses so that you can replenish it quickly. Some damage can be permanent when it comes to B1 thi, which is why I would say we were so aggressive. So we know that when you progress to some of the wernickes and the Korsakoff, those sometimes can’t be reversed.

Rapid Replenishment and Monitoring

(43:55):

We can’t correct some of that damage and that nerve damage that occurs and you’re walking or your gait. Even with the foot drop and things, sometimes we can’t fix it. So that’s why out of the gate we always wanted to be more aggressive. So if somebody right after surgery was having nausea, vomiting, diarrhea and they couldn’t catch up, they were getting depleted quickly because they were losing all of this food that they’re consuming and not really getting much nutrition, then that’s where that would help protect us. That would help protect and prevent a rapid depletion of those levels. We also have to think about refeeding syndrome, and this is where that if you replenish someone too quickly with nutrients like with food and fluids even, so making sure it’s packaged together with magnesium, potassium, phosphorus will help prevent the complications of refeeding syndrome. And then continuous monitoring and SIBO considerations.

SIBO and Chronic Thiamine Deficiency

(45:14):

So again, checking your thiamine levels and then also evaluating symptoms. If someone is saying, Hey, I have constipation and diarrhea kind of go back and forth, or one extreme or the other, and they’re also having bloating and they just seem to be reacting to food and their stomach just hurts all the time, they don’t feel great, then we could assess them for sibo and that could be the driver of their vitamin B1 deficiency. And I will say that I did have a patient for years that I worked with, and she truly did struggle with sibo, and we struggled to get that resolved because the practitioners she worked with didn’t seem to have belief in SIBO or really the knowledge to treat it. So we kept running into roadblocks because she had to use her insurance and couldn’t really do cash pay on anything. So she kind of got trapped in the system and was really difficult to treat because they just would not prescribe her the medications, and she really didn’t have the resources to purchase the antimicrobial forms to do it a different way.

Benfotiamine for Enhanced Absorption

(46:38):

And she chronically was low in thiamine, I mean chronically. And we would give high doses like always, and it would never replenish. She could never get it replenished and she’d had IV thiamine a few times. So again, just another way to assess kind that lab. Look, I’ve talked about vitamin BB 12 and RBC folate. B 12 can be low, but also B1 could be low. But RBC folate B high being a lab look for sibo. And again, this is where having a skilled practitioner who understands this connection is important. Because they can put the puzzle together and get you better faster. So the Benfotiamine is the fat-soluble form of B1, and this is something that. I would like to use with patients when they are struggling. Kind of like that example of my patient who unfortunately did not have the resources to purchase this product because it is something that you get from a supplement company, but her insurance wasn’t going to cover it and she didn’t have the resources to purchase otherwise.

Benfotiamine Multi Faceted Benefits

(48:05):

So again, it became this issue. But this Benfotiamine is the fat-soluble form. So it’s more highly absorbable and more readily available for absorption. Some of the studies have shown has enhanced bioavailability because of it being fat soluble. It’s more effective at absorbing and tissue penetration than water soluble supplements. So again, in some studies they did show a fivefold improvement in bioavailability, also has anti-inflammatory properties and Benfotiamine has been demonstrate to inhibit active signaling pathways that participate in the inflammatory process. And it can help really treat with chronic illness associated with underlying inflammation. So think about obesity, that low grade inflammation that is occurring. So if you’re struggling with your weight being stuck, addressing the inflammation piece is part of it. We have to get the inflammation down for you to be successful with weight loss. Benfotiamine also provides some neuroprotection and it promotes nerve regeneration and health, making it a great therapy for anyone who is having neuropathy pain.

Vitamin B1 Food Sources

(49:37):

It can also help with diabetics who experience problems with glucose metabolism and their nerve function. So utilizing this form of vitamin B1 is important, especially if you have diabetes. And Benfotiamine is also going to be beneficial for neuropathy management, cardiovascular health, mental health, Alzheimer’s disease. All of those including the diabetes and improved blood sugar control. All of those are going to perform better with using the fat soluble form or the Benfotiamine as opposed to a water-soluble form. So what are some of the B1 food sources? Asparagus, brown rice, cantaloupe, salmon, the wild caught salmon, flax seeds, green peas, lentils, milk, orange and pecans. All of those have significant sources of vitamin B1 in them that can give additional input of this vitamin to your body. So this is where getting a variety of foods in your diet is so important. Because it can provide you with a different vitamins, minerals, phytonutrients, antioxidants that you won’t get otherwise.

Conclusion

(51:03):

So let’s wrap this up. So vitamin B1, thiamine is a crucial element of post-bariatric nutrition and health. And research suggests that benfotiamine the fat soluble form of vitamin B1 could be helpful. Because thiamine deficiency can affect blood sugar, mental health, heart health, and might be link to Alzheimer’s disease. So maintaining a varied diet where you’re getting a variety of different foods that contain thiamine is important. As well as taking your supplementation as recommended by your bariatric team. And then most importantly, getting those annual labs draw and making sure that. You’re staying on top of those levels, that it never drops too low. So I hope this has helped and you’ve enjoyed learning a little bit about vitamin B1 thiamine. And its role in your success after weight loss surgery. So you guys have a great week and we will see you next time. Bye-Bye.

Listen, Learn, Enjoy…

1. 1. Polegato, B. F., Pereira, A. G., Azevedo, P. S., Costa, N. A., Zornoff, L. A., Paiva, S. A., & Minicucci, M. F. (2019). Role of thiamin in health and disease. Nutrition in Clinical Practice, 34(4), 558-564.

   2. Martel, J. L., Kerndt, C. C., Doshi, H., & Franklin, D. S. (2018). Vitamin B1 (thiamine).

   3. Osiezagha, K., Ali, S., Freeman, C., Barker, N. C., Jabeen, S., Maitra, S., Olagbemiro, Y., Richie, W., & Bailey, R. K. Thiamine Deficiency and Delirium. Innovations in Clinical Neuroscience, 10(4), 26-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659035/

   4. Wilson, R. B. (2020). Pathophysiology, prevention, and treatment of beriberi after gastric surgery. Nutrition Reviews, 78(12), 1015-1029. https://doi.org/10.1093/nutrit/nuaa004

   5. Albaugh, V. L., Williams, D. B., Aher, C. V., Spann, M. D., & English, W. J. (2021). Prevalence of thiamine deficiency is significant in patients undergoing primary bariatric surgery. Surgery for Obesity and Related Diseases, 17(4), 653-658. https://doi.org/10.1016/j.soard.2020.11.032

   6. Bahardoust, M., Eghbali, F., Shahmiri, S. S., Alijanpour, A., Yarigholi, F., Valizadeh, R., … & Khanafshar, E. (2022). B1 Vitamin Deficiency After Bariatric Surgery, Prevalence, and Symptoms: a Systematic Review and Meta-analysis. Obesity Surgery, 32(9), 3104-3112.

   7. Wiley, K. D., & Gupta, M. (2019). Vitamin B1 thiamine deficiency.

   8. Smith, T. J., Johnson, C. R., Koshy, R., Hess, S. Y., Qureshi, U. A., Mynak, M. L., & Fischer, P. R. (2021). Thiamine deficiency disorders: a clinical perspective. Annals of the New York Academy of Sciences, 1498(1), 9-28.

   9. Shible, A. A., Ramadurai, D., Gergen, D., & Reynolds, P. M. (2019). Dry beriberi due to thiamine deficiency associated with peripheral neuropathy and Wernicke’s encephalopathy mimicking Guillain-Barré syndrome: a case report and review of the literature. The American Journal of Case Reports, 20, 330.

   10. Wijnia, J. W. (2022). A Clinician’s View of Wernicke-Korsakoff Syndrome. Journal of Clinical Medicine, 11(22), 6755.

   11. Gomes, F., Bergeron, G., Bourassa, M. W., & Fischer, P. R. (2021). Thiamine deficiency unrelated to alcohol consumption in high‐income countries: a literature review. Annals of the New York Academy of Sciences, 1498(1), 46-56.

   12. Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., … & Still, C. D. (2020). Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures–2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surgery for Obesity and Related Diseases, 16(2), 175-247.

   13. Onishi, H., Uchida, N., Itami, K., Sato, M., Tamura, S., Kurosaki, A., & Ishida, M. (2020). Subclinical thiamine deficiency: What is the most appropriate method of diagnosis and treatment?. Palliative & Supportive Care, 18(5), 614-616.

   14. Xu, Y., Zhao, L., Qiu, H., Qian, T., Sang, S., & Zhong, C. (2021). The impact of thiamine deficiency and benfotiamine treatment on Nod-like receptor protein-3 inflammasome in microglia. Neuroreport, 32(12), 1041-1048.