As the number of Americans who are overweight has grown, so have the numbers of bariatric surgeries. About one-third of U.S. adults are now overweight or obese. In 2008, an estimated 220,000 extremely obese Americans underwent bariatric surgery to reduce the size of the stomach or bypass it entirely, according to the American Society for Metabolic and Bariatric Surgery. While bariatric surgery can improve quality of life and even save lives, it often also introduces mild to serious neurological conditions. These conditions result from a reduction in food intake and the inability to absorb nutrients following bariatric surgery.
Peripheral Neuropathy
Peripheral neuropathy is nerve damage that causes pain, numbness or tingling in hands, feet and other parts of the body. The development of peripheral neuropathy after bariatric surgery is associated with vitamin B-1 (thiamine) deficiency. About 16 percent of people who underwent bariatric surgery developed peripheral neuropathy, according to one study of more than 400 people conducted by the Mayo Clinic. The patients were more apt to develop peripheral neuropathy if they lost a large amount of weight in a short period, if they recovered slowly after surgery and if they didn't take part in nutritional counseling after surgery.
The researchers believe that malnutrition puts bariatric surgery candidates at risk for peripheral neuropathy, and they recommend that anyone planning to have bariatric surgery attend nutritional clinics.
Wernicke's Encephalopathy
Some bariatric surgery patients, especially young women who experience vomiting after the surgery, have developed Wernicke's encephalopathy due to insufficient amounts of thiamine. The symptoms of Wernicke's encephalopathy are confusion, short-term memory and vision loss and loss of muscle coordination. In the patients studied, the condition generally appeared four to 12 weeks after surgery. If untreated, it can advance to coma and cause death.
Myelopathy (Human Swayback)
Since the surgery has only been performed for a couple decades, the long-term effects of bariatric surgery are not known. However, physicians are seeing some neurological complications develop years after the surgery due to long-term deficiencies in certain nutrients and minerals. Myelopathy--a complication of the spinal cord that causes gait and other movement problems--is now being observed somewhat frequently in people about 10 years after bariatric surgery, according to a study published in Mayo Clinic Proceedings.
Researchers know that copper deficiency is one known cause of myelopathy since copper supplements generally help the patients recover quickly. Insufficient amounts of vitamin B12 are also believed to contribute to the development of myelopathy.
Besides deficiencies in thiamine, B12 and copper, people undergoing bariatric surgery are at risk for developing deficiencies of calcium, phosphate, vitamin D, iron, folate, riboflavin, and vitamins A, E and K, which together or singly may lead to neurological complications, according to the journal Neurology's "Patient Pages."
References
- National Institute of Diabetes, Digestive and Kidney Diseases: LABS
- MayoClinic.com: Peripheral neuropathy
- Neurology.org: A controlled study of peripheral neuropathy after bariatric surgery
- Neurology.org: Wernicke's Encephalopathy
- Mayo Clinic "Proceedings": Copper Deficiency Myelopathy (Human Swayback)
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