UAMS Study Links Gastric Bypass Surgery, Neurological Conditions

[saucywench]

This is a drop-and-run post, as I have to get back to work, so no personal comment is offered at this time. This study was conducted at mine and Joy's place of employment:
http://www.uams.edu/_images/blank.gif

MAY 23, 2007 | A decade-long study by neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock has found a link between the increasingly popular weight-loss surgery known as gastric bypass and several serious neurological conditions.

Katalin Juhasz Pocsine, M.D., associate professor in the UAMS Department of Neurology, is lead author of the study, which was published online May 22 in the medical journal Neurology (www.neurology.org/cgi/content/abstract/68/21/1843 (http://www.neurology.org/cgi/content/abstract/68/21/1843)). The study concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and may develop a variety of neurological symptoms.

“The frequency of operations for treatment of obesity is rapidly growing in the United States,” Juhasz Pocsine said. “These procedures are usually successful in reducing weight, but they are not without risk. Many of the complications patients experience affect the nervous system, and they are often disabling and irreversible.”

More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients, a link between the surgery and their neurological condition was found.

All of the patients involved in the study had previously undergone the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.

Additional authors include UAMS Department of Neurology faculty members Sami I. Harik, M.D., department chairman and professor of neurology; Stacy A. Rudnicki, M.D., associate professor of neurology; and Robert L. “Lee” Archer, M.D., associate professor of neurology.

The 26 people involved in the study were followed for several years by UAMS physicians and represent the largest compilation of gastric bypass patients with neurological complications ever reported.

“As is evident from our findings, the neurological complications of bariatric surgery involve most parts of the nervous system, and frequently more than one,” Juhasz Pocsine said. “The conditions experienced by our patients spanned most regions of the nervous system from the cerebral cortex to the peripheral nerves.”

Symptoms of the patients in the study included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.

Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.
“Attention should be given to long-term intake of vitamin and mineral supplements to prevent some of these complications and to avoid severe and rapid weight loss,” Juhasz Pocsine said. “Patients should be made aware of the symptoms that herald these neurological complications, and physicians should attend to the wide-based nutritional deficiencies as early as possible.”

www.uams.edu (http://www.uams.edu).

[SamanthaNY]

Wow. Interesting - and kinda scary. I wonder if this will lead to changes in the surgery, post-op neurological testing and evaluation or mandatory nutritional IV treatments... or something along those lines.

Is there any data for symptoms and damage correlated by amount of time post-op?

Thanks for posting, Sauce.

[Miss Vickie]

You're right, Samantha, it's scary. I've found that this far out I feel so NORMAL that I do have a harder time remembering about my supplements; it was much easier in the beginning when I felt like a WLS patient, something I don't feel like now. I was a very naughty girl on vacation and am whipping myself back into shape now.

I wonder how reliable the laboratory levels they have are. I know people who are within the normal ranges for nutrients but have many symptoms of someone who is deficient. It just makes me wonder if we need to revisit those levels.

[SamanthaNY]

I think that's a real danger, Vicki - patients reach their goals, feel the 'normal' that you mentioned, and start to forget that their insides are now vastly different and require ongoing special care. Though I'm glad this information is finally coming out, I wonder what other side effects will be discovered as WLS develops, and patients reach farther and farther postop dates. It seems strange to me that it's been around some 15 years, and this info is only coming out now. That's why I made the earlier post inquiring about data by postop dates.

If this continues (and I don't see how it can't, sadly) I envision some sort of implantable nutrient delivery system that's placed in the intestinal wall or something (akin to an insulin pump, perhaps?)- so at least the neurological effects can be avoided. It could even be something with a port so that levels could be instantly 'refilled', but would last several weeks or months, so the patient wouldn't have to remember to take pills every day.

I still dream of a day when WLS isn't necessary though - when they've stopped treating the symptom instead of the cause.

[GenericGeek]

I think that Vickie's right -- it's quite possibly more of a 'patient compliance' issue, rather than something completely unanticipated, about gastric bypass procedures.

So more patient eduction & followup is certainly a very good idea. I think it may be somewhat like trying to get someone to diligently follow their cholesterol-lowering &/or blood pressure meds. The long-term consequences of neglecting your medication regimen are disastrous, but there's no immediate symptoms to act as a "reminder" to keep you on track. It's easy to forget, especially when your regular routine is disrupted (as when you're on vacation.)

It's interesting. The "malabsorptive procedures" for WLS (such as gastric bypass) are still considered the "gold standard", according to the lit survey my insurance company makes available (they still won't PAY for WLS, but at least they're good enough to have lots of info. about it on their Web site!) This is because RnY, etc. statistically get more people closer to those ridiculous Met Life "Everyone must weigh this!" table numbers, more quickly, than less drastic procedures, such as the Lap-band.

The latter is quite a bit slower (for many people), and less likely to get you quite as thin, quite as fast, but pretty much works by portion control alone, meaning that your gut's ability to extract nutrients from the food you take in is not impeded. However, it's still possible to become malnourished if you eat "bad" foods, in preference to healthy ones that contain an adequate amount of the right vitamins, minerals, etc.

[moniquessbbw]

My doctor have an amazing post surgery program. All of my levels are tested every 90 days to make sure I am on track. I make sure I take all of my vitimans daily and once a month I get a B-12 shot.

[Rowan]

If Id read this before last week I'd try to be a smart ass and say "Ohhhh that's what's wrong with me"...however...last friday..met with a psychiatrist who graciously told me...."No Rowan....you arent a nut job"...what a relief. I'm just vitamin deficient from my own experience with g/b. So guess there is truth to that...
:doh:

[Mechelle]

This is absolutely true, I have to take multivitamins and calcium daily and get checked every 3 months for levels. So far so good! I am actually taking a statistics class right now and I wonder about the control group for the study. Both underweight and overweight are medically considered malnurshed I learned that in a nursing class, it is possible to be over weight and have significantly low values of blood serum vitamins. I would be interested in the control group. The group that recieved the WLS would infact have been overweight... but was the control group overweight as well, was their nutritional base line the same as the baseline for the subject group before WLS? Regardless of the study everyone I know that has had WLS are very diligent about follow ups because of the problems you can suffer regarding malnutrition after WLS.

[tonynyc]

Just a general question regarding vitamin intake... Does it make much difference if you are taking Liquid Vitamin Supplements vs. Pills?

[Mechelle]

The biggest difference of pills vs liquid is how much of the pill dissolves. I personally break my pills into two or three pieces to make them no bigger then a pencil eraser. The absorption of different vitamins depends on other factors. Calcium needs an acidic environment to absorb best, also vitamin D which is why milk is fortified with vit D. Vitamin B12 absorbs in the part of the intestine that is closest to the stomach so that is bypassed in WLS so one needs to mega dose to get enough to absorb. Liquid is good because it is pre-dissolved but doesnt mean it will be better absorbed, there are more factors to absorption.

[SocialbFly]

what i have read is that a lot of the vitamins that are best absorbed are done with food, when you have a very small stomach pouch it is hard to do with pills...the wls doc here at Wash U actually recommends liquids (or at least did the last time one of my friends had wls)

the neuro symptoms seem to mostly be related to B vitamins which have been getting lots of publicity lately....so, i guess maybe that is what should be looked at closely...i know b vitamin deficits can have significant neuro symptoms...

goes without saying that continued monitoring and follow up is important...but as Vickie stated, many people have more problems with that as they become more involved in their every day life...

[TraciJo67]

You're right, Samantha, it's scary. I've found that this far out I feel so NORMAL that I do have a harder time remembering about my supplements; it was much easier in the beginning when I felt like a WLS patient, something I don't feel like now. I was a very naughty girl on vacation and am whipping myself back into shape now.

I wonder how reliable the laboratory levels they have are. I know people who are within the normal ranges for nutrients but have many symptoms of someone who is deficient. It just makes me wonder if we need to revisit those levels.

Vickie, this is exactly my problem too. I feel so great most of the time, and it is a struggle to remember to take my vitamins & supplements every day. While I've been here in Malaysia, a few months went by when I wasn't taking anything at all. I told myself that I'm "normal" now, especially as I've gained some weight so am obviously absorbing some nutrients. I started taking them again when I had an episode one evening when my toes started to twitch and I developed some horrible cramps in my lower legs. I don't even know if that is related to a deficiency, as the doctors here aren't familiar with gastric bypass (at least, not the ones I've been to for colds, flu, traveler's disease, etc). As soon as I return to the states, I plan on getting my blood drawn. I know I must be quite healthy, as I feel really good .... but will feel better once that is confirmed by tests. I was so determined that I was going to comply with all recommendations when I first had surgery, but find that as time went on, it became easy to slip into complacency. I have a feeling that this is a very common thing for post-ops.

[Miss Vickie]

Honey I'm glad you're going to get seen when you get back to the US. Those pains you're describing sound like a mineral deficiency -- maybe calcium, magnesium, or even potassium. Do you have access to any supplements while you're there? I assume you've run out by now; is it hard to get replacements? If you want me to send you some to hold you until you get back, just pm me, okay?

And yeah, it's easy to think "I'm fine" but our insides are forever altered, and even though we're absorbing fat quite nicely (!!!) it doesn't necessarily follow, unfortunately, that we're absorbing nutrients.

Would that it were so...

[Shosh]

Hi, Well I have a neurological condition (Multiple Sclerosis) and I have had it since my early twenties. I turned 37 recently. Neurological conditions can be very hard to diagnose and the causes of many diseases are just not known. I don't know that anybody could really link vitamin deficiancy with the onset of neurological conditions. I had this disease long before I was banded this year. I may have gotten it after I was banded also, but who is to say conclusively how I got it? I am the only person in the history of my entire family who has ever had this disease. Freaky really.
Susannah

[janie]

are these deficiencies also present with the lapband too?

[Miss Vickie]

Hi, Well I have a neurological condition (Multiple Sclerosis) and I have had it since my early twenties. I turned 37 recently.

I'm so sorry you struggle with MS. A good friend's husband has it and so far (fingers crossed) he's doing very well. In fact they just got back from a jaunt back east to visit family, went to a kayaking class today and are leaving in a couple of days for a big ol' camping and kayaking trip southeast of here. He works full time with a very demanding job, and they have a very active lifestyle with lots of camping and hiking. So far it hasn't slowed him down at all. This same friend has a friend who she's known for some time who is wheelchair bound -- or was until last year when a really concerted effort with PT has made it so that she can walk with a walker.

There's just so much we don't know...

Neurological conditions can be very hard to diagnose and the causes of many diseases are just not known. I don't know that anybody could really link vitamin deficiancy with the onset of neurological conditions.

You're right, it's just so hard to say. I mean, there are certain nutritional deficiencies (B vitamins) that are linked with peresthesia (numbness, and I probably mangled that spelling but I'm a nurse not an English teacher). So it seems pretty clear that with bypass, if you're not careful with supplementing, you could end up in that boat.

I had this disease long before I was banded this year. I may have gotten it after I was banded also, but who is to say conclusively how I got it? I am the only person in the history of my entire family who has ever had this disease. Freaky really.
Susannah

Have you noticed a difference with your MS since your surgery? I'm curious to see how things have progressed. I also suffer from a chronic disease -- Sarcoidosis -- and fully expected my Sarc to get way worse since the way I thought I was keeping it even moderately under control was with nutritional supplementation. Well, I saw my lung doc a couple of weeks ago and he feels that it's either gone or is going into remission.

Go figure.

Again, so much we just don't know.

[Shosh]

are these deficiencies also present with the lapband too?

Hi,From what I can ascertain the issue with vitamin deficiency is more associated with gastric bypass surgery than the lap band. I do take vitamins daily though as directed by my surgeon and dietician.
I guess everybody who has had surgery of any kind and those who haven't should really be ensuring adequate intake of the correct vitamins and minerals daily. Obviously those who have had GBS have to take more supplements and take them more religiously.
Susannah

[Shosh]

Hi Vikie, Thankyou for your very detailed responses to my post here on this thread and on the other thread. I appreciate the support.
My MS is currently quite stable and in remission, although the disease does progress silently in the nervous system during such remissions. I had a nasty relapse of it last year, and a big relapse in 2004. In 2004 I was having trouble walking and trouble controlling my bowels and bladder, It was hard.
MS is a very bizarre disease. It behaves very differently in every person that has it.
I am currently very well, and I am exercising 5 times per week and back working a very demanding job also. To look at me you wouldn't even know I have the disease at the moment! That could all change at any time, but I live for now and not next year etc.
I am not familiar with your ailment.How does it effect you?
Susannah