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.
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.
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). Call your doctor immediately if you experience the above symptoms.
Persons with chronic alcoholism have low thiamine intake, impaired thiamine uptake and storage, accelerated destruction of thiamine diphosphate, and varying degrees of energy expenditure. Alcohol is a direct neurotoxin. The effects on the body's supply of thiamine and on brain tissue are detrimental. Persons with known alcoholism should be administered parenteral thiamine as a routine action when they present to a medical facility.
The best treatment is prevention. Take 1 tablet (100 mg) of Vitamin B1 (Thiamine) daily for a few weeks before your gastric bypass surgery and continue it for the first 6 months.
Treatment of acute thiamine deficiency
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.