thiamin? question for a nutritionist...
i'm not really sure what this means but i was hoping a nutritionist would come along and help me out. i had to go to my local walk-in clinic yesterday and get two saline bags (i really needed about two more but didn't have time for all that.) anywho, it has recently come to my attention that we're supposed to be administered thiamin at the same time as an iv due to the risk of beri beri. unfortunately though, neither of my bags had thiamin and i didn't know about this until just now. and when i call the clinic about this they laugh at me and tell me that beri beri doesn't exist in the united states and that i'm a moron for even questioning their judgment. so, who's right? do we need thiamin or not? is this a real risk or not? does beri beri exist in the united states or not? and if so, what do i need to do about this now, after the fact? is there some sort of supplement i can take or am i just screwed or what??
I'm not a nutritionist, but I know the answer to your question - so I hope you don't mind if I chime in.
1) You are right.
2) We DO need thaimin (one of the B vitamins) because our stores are so small that we need DAILY replacement.
3) There IS a real risk.
4) Beriberi has been eliminated from most of the world because of fortified foods, however the majority of fortified foods are ones that WLS post-ops tend to eat the LEAST of (breads, etc). Considering the body only stores about 30 mg of of thiamin and it only has a half-life of about 2 weeks, even a short spell of vomiting and/or UNDER eating enough thiamin fortified foods can cause a deficiency.
5 & 6) NOW (since you have already I guess had this IV), I would start a good B-Complex vitamin immediately. It can't hurt and should help get your thiamin stores back up to where they should be. (B-Complex is something I believe EVERY post-op should take, whether they have an IV or not. It is very hard to get TOO much B-Complex vitamins and some side effects of deficiency are PERMANENT once they occur, ie death, coma, neurological damage, etc.) For early deficiencies, 20-30 mg of thiamin per day is recommended until symptoms abate. For late deficiencies, 50-100 mg of thiamin per day is recommended until symptoms abate. Since you have not said you are symptomatic, I'd just start a good B-Complex vitamin if it was me. But obviously check with your surgeon to make sure it is okay with them. (I'm sure it will be. Like I said - it can't hurt.)
For the clinic that laughed at you, I'm quoting this from the recent article published for the American Society for Metabolic and Bariatric Surgery titled Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient.
>>>>>
Beriberi has been observed after gastric restrictive and malabsorptive procedures. A number of cases of Wernicke-Korsakoff syndrome (WKS), as well as peripheral neuropathy, have been reported for patients having undergone vertical banded gastroplasty [53– 61]. A few incidences of WKS have also been reported after AGB [43,62,63]. Additionally, reports of thiamin deficiencies and WKS after RYGB [40,41,64 –73] and several cases of WKS and neuropathy in patients who had undergone BPD [74] have been published. Many more cases of WKS are believed to have occurred with bariatric procedures that have either not been reported or have been misdiagnosed because of limited knowledge regarding the signs and symptoms of acute or severe thiamin deficits. Because many foods are fortified with thiamin, beriberi has been nearly eradicated throughout the world, except for patients with severe alcoholism, severe vomiting during pregnancy (hyperemesis gravidarium), or those malnourished and starved. For this reason, few healthcare professionals, until recently, have had a patient present with beriberi.
Bariatric beriberi can also develop in postoperative patients who are given infusate containing dextrose without thiamin and other vitamins, which is often the case for patients receiving care in critical care units, postoperative patients with complications interfering with the ingestion of food, or patients dehydrated from persistent vomiting.
1) You are right.
2) We DO need thaimin (one of the B vitamins) because our stores are so small that we need DAILY replacement.
3) There IS a real risk.
4) Beriberi has been eliminated from most of the world because of fortified foods, however the majority of fortified foods are ones that WLS post-ops tend to eat the LEAST of (breads, etc). Considering the body only stores about 30 mg of of thiamin and it only has a half-life of about 2 weeks, even a short spell of vomiting and/or UNDER eating enough thiamin fortified foods can cause a deficiency.
5 & 6) NOW (since you have already I guess had this IV), I would start a good B-Complex vitamin immediately. It can't hurt and should help get your thiamin stores back up to where they should be. (B-Complex is something I believe EVERY post-op should take, whether they have an IV or not. It is very hard to get TOO much B-Complex vitamins and some side effects of deficiency are PERMANENT once they occur, ie death, coma, neurological damage, etc.) For early deficiencies, 20-30 mg of thiamin per day is recommended until symptoms abate. For late deficiencies, 50-100 mg of thiamin per day is recommended until symptoms abate. Since you have not said you are symptomatic, I'd just start a good B-Complex vitamin if it was me. But obviously check with your surgeon to make sure it is okay with them. (I'm sure it will be. Like I said - it can't hurt.)
For the clinic that laughed at you, I'm quoting this from the recent article published for the American Society for Metabolic and Bariatric Surgery titled Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient.
>>>>>
Beriberi has been observed after gastric restrictive and malabsorptive procedures. A number of cases of Wernicke-Korsakoff syndrome (WKS), as well as peripheral neuropathy, have been reported for patients having undergone vertical banded gastroplasty [53– 61]. A few incidences of WKS have also been reported after AGB [43,62,63]. Additionally, reports of thiamin deficiencies and WKS after RYGB [40,41,64 –73] and several cases of WKS and neuropathy in patients who had undergone BPD [74] have been published. Many more cases of WKS are believed to have occurred with bariatric procedures that have either not been reported or have been misdiagnosed because of limited knowledge regarding the signs and symptoms of acute or severe thiamin deficits. Because many foods are fortified with thiamin, beriberi has been nearly eradicated throughout the world, except for patients with severe alcoholism, severe vomiting during pregnancy (hyperemesis gravidarium), or those malnourished and starved. For this reason, few healthcare professionals, until recently, have had a patient present with beriberi.
Bariatric beriberi can also develop in postoperative patients who are given infusate containing dextrose without thiamin and other vitamins, which is often the case for patients receiving care in critical care units, postoperative patients with complications interfering with the ingestion of food, or patients dehydrated from persistent vomiting.
Caution should be used when infusing bariatric patients with infusate containing dextrose without a multivitamin and additional thiamin, because an increase in glucose use without additional thiamin can deplete thiamin stores [76].
<<<<<
If you want to print the entire article FOR them (or read it yourself), here is the link. The information I quoted above is on pages 10 (second colum) and 11 (first column).
http://download.journals.elsevierhealth.com/pdfs/journals/15 50-7289/PIIS1550728908001639.pdf
Hope this helps...
Wen
I wouldn't worry too much about beriberi resulting from your getting intravenous fluids, but it's prudent to take extra thiamine if you've had RNY surgery. I originally took a thiamin tablet 100mg daily. Eventually I switched to "Nature Made Super B Complex" tablets which contains 100mg of thiamine along with other B vitamins and vitamin C. Note that "Super B Complex Liquid Softgels" are not the same formulation as the tablets and contain much less thiamin, so you don't want those.
/Steve
/Steve
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