Water Soluble Vitamins

The Science of Supplementation: Water-Soluble Vitamins, Part 1

February 14, 2018

Previously I reviewed the overall digestion process before and after WLS; now, I’ll be diving into individual micronutrients and their importance in our daily functioning for our bodies. To start us off, we’ll be looking at water-soluble vitamins.

Water-Soluble Vitamins, Part 1

These vitamins, like the name sounds, dissolve in water and can, therefore, be quickly transported into the body, as our bodily fluids are water-based. However, this means that these vitamins cannot be stored in our body, as our body stores nutrients in the form of fat, and we all can remember that oil (fat) and water don’t mix. When we lose bodily fluids through sweat, urinating and pooping (yes, us dietitians love to talk about poop habits!), we also lose these water-soluble micronutrients.

Because our body cannot properly store or recycle these water-soluble vitamins, we need to make sure that we consume them in our diet and via supplements, and avoid vitamin deficiencies. And because our bodies do not store these nutrients, toxicity from too much water-soluble micronutrients is rare.

Thiamine (B1)

Thiamine functions to help us convert nutrients into energy, and to help with carbohydrate formation in our bodies. We are at an increased risk of deficiency during malnutrition, rapid weight loss, and/or excessive alcohol use. With the rapid weight loss that occurs with WLS, it is very important to make sure we have sufficient thiamine.

Symptoms of thiamine deficiency include delayed gastric emptying, nausea, vomiting, and constipation. Deficiency in thiamine can lead to a condition called beriberi that is categorized as either dry or wet. Dry beriberi is characterized by muscle weakness, pain in the extremities, and convulsions. Wet beriberi is characterized by edema (fluid retention and swelling), irregular heart rate, shortness of breath, and hypertension (high blood pressure), which can lead to heart failure.

Advanced thiamine deficiency can lead to Wernicke’s encephalopathy, which is characterized by confusion, memory loss, ataxia (gait abnormalities), and a variety of ocular changes. If the deficiency progresses, it can lead to Wernicke-Korsakoff syndrome, which is irreversible and includes psychosis and/or hallucinations.

There are no documented cases of toxicity from thiamine, so no tolerable upper intake level (UL) has been established.

The best sources of thiamine include whole grains, nuts, and seeds, pork and liver. Liver, in fact, is one of the best sources of many vitamins and minerals. However, as post-op patients we are at ongoing risk of deficiency due to malabsorption and decreased intake, so beyond consuming a healthy diet, it is recommended for us to supplement. The updated American Society for Metabolic and Bariatric Surgery (ASMBS) Guidelines for supplementation are found below:

DRI AGB SG RYGB
Thiamin 1.2 mg M
1.1mg F		 12mg minimum
50-100 mg at risk		 12mg minimum
50-100 mg at risk		 12mg minimum
50-100 mg at risk

Riboflavin (B2)

Riboflavin functions as a coenzyme to help convert the nutrients that we eat into energy. It is specifically involved in converting tryptophan (the amino acid we associate with the turkey at Thanksgiving) into niacin (vitamin B3), and for converting vitamin B6 into its active form.

Good sources of riboflavin include liver, hard goat cheese, and almonds, as well as dairy products, eggs, meat, leafy vegetables, legumes, and mushrooms. Riboflavin is also used as a food coloring, contributing a yellow-orange color, so it can be found in fortified cereals and other processed foods.

It is rare to experience a riboflavin deficiency in the United States. However, excessive alcohol use increases the risk of deficiency, as does an unhealthy diet and getting older. Physical symptoms of ariboflavinosis, a severe case of riboflavin deficiency, include a sore throat and swollen tongue, as well as problems with your skin and eyes. Anemia can also result, which is difficult to diagnose without blood tests. As mentioned with its function, deficiency in riboflavin can also impair the process of converting vitamin B6 and tryptophan.

Like thiamine, there are no known toxicity effects and no UL for riboflavin. Because deficiency is also so rare, there are no specific guidelines from ASMBS on the quantity of riboflavin to supplement.

Niacin (B3)

Niacin, as we have learned, can be formed in our body from tryptophan, an amino acid found in protein-based foods. In fact, niacin is the only B vitamin that our body can produce.

Niacin is very important, as it is converted into nicotinamide adenine dinucleotide (NAD) or nicotinamide adenine dinucleotide phosphate (NADP), which both act as coenzymes in a magnitude of reactions for cellular function in our bodies. Specifically, it is necessary in glycolysis, which is the breakdown of sugar into energy for our bodies to use.

Good sources of niacin are liver (surprise!), peanuts, poultry, pork, and sunflower seeds. It is also found in yeast extract, dairy products, and mushrooms. Like thiamine and riboflavin, it is also found in fortified cereals.

Pellagra, or niacin deficiency, results in the physical symptoms of diarrhea, mouth sores, and inflamed skin. Pellagra can also lead to insomnia and dementia. Luckily, in the United States, pellagra is rare as we are able to eat a varied diet, and our body can produce it from tryptophan.

There are no known adverse effects from the niacin found in our foods. However, the form of niacin most commonly found in supplements can lead to “niacin flush.” Just like it sounds, this is characterized by a flush to the upper body and can occur when you have high doses of nicotinic acid in a supplement. It does not last for an extended period, but it is a good sign that your body cannot tolerate that dose of niacin. Despite being a water-soluble vitamin, long-term high dosing of niacin supplements can lead to liver damage. Niacin has an established UL, the highest amount considered safe, and for men and women 14+ years old that amount is 30mg/day. The adverse effects are more typically found with doses between 3-9g/day—which is 100-300 times the amount suggested for the UL.

Luckily, as post-ops, we are encouraged to eat a high protein diet, so a niacin deficiency is rare among us. But recall, if we don’t have enough riboflavin, we won’t be able to efficiently convert the tryptophan from the protein we eat into niacin, so eating a varied diet and supplementing helps our health on multiple levels.

Water Soluble Vitamins Summary

While riboflavin and niacin don’t have established supplementation values from ASMBS, they are still two very important micronutrients for energy metabolism. Thiamine has an established supplementation value and is key during times of rapid weight loss.

These are just the first three of the water-soluble micronutrients. Please stay tuned for my next article, which will be looking at pantothenic acid (vitamin B5), vitamin B6, and everyone’s favorite, biotin!

Terms

UL: tolerable upper intake level, DRI: dietary reference intake, AGB: adjustable gastric band, SG: sleeve gastrectomy, RYGB: Roux-en-Y gastric bypass

References

Water Soluble Vitamins

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ABOUT THE AUTHOR

Bec McDorman, MS, RDN discovered her passion for health and wellness after undergoing Roux-en-Y Gastric Bypass surgery in 2010 to lose more than 100lbs. Bec has received her masters from Cal Poly Pomona and completed her dietetic internship at Johns Hopkins Bayview Medical Center. She has reached her goal of being a registered dietitian so she can help pre- and post-op bariatric patients with their journey.

Read more articles by Bec!