Recently I was talking with a co-worker to strategize about how to get more accurate follow-up with a program in another department. My co-worker observed that everything was fine until the program’s coordinator had bariatric surgery, “Haven’t you noticed that Susie was on top of the details until after her surgery last year? She isn’t the first person I’ve known who looks great from weight loss surgery but seems to have lost a couple of IQ points.”
It was a startling moment to think that so many people who undergo surgery to battle morbid obesity could be at risk for such a side effect. I immediately took a virtual trip to the National Library of Medicine, entering keywords related to neurological complications after bariatric surgery. Within seconds a number of scientific article titles from around the world appeared in the results, such as:
While there were some results on the other side of this spectrum (such as “Improved Memory Function 12 Weeks after Bariatric Surgery,” I was drawn to read more about the tantalizing lead that nutritional deficiency could be what was causing a decline in the quality of our colleague Susie’s work.
The University of Pennsylvania researchers said that the estimated incidence of neurological complications stemming from nutritional deficiencies in the wake of bariatric surgery could be as high as 16% of patients. Common deficiencies include “thiamine (B1), B12, folate, vitamin D, vitamin E, and copper.” The risks for the deficiencies could be traced to “vitamin noncompliance, protracted vomiting, and excessive alcohol consumption.” Some vitamin deficiencies occur within weeks of surgery, if patients don’t take vitamin supplements as prescribed (such as B1), while other vitamin deficiencies might not show up for years because of the time it takes to deplete the body’s natural stores (such as B12).
The University of Alberta study reported only outcomes for bariatric surgery patients who never attended a post-surgery nutritional clinic. Two of the patients developed the clinical features Parkinson’s disease. Vitamin replacement therapy “resulted in a slow and variable degree of neurologic recovery.”
The French researchers stress that nutritional deficiency depends upon the type of surgery performed and the percentage of weight loss. Neurological complications such as encephalopathy (altered mental state, could include decreased cognitive function) are more rare than other complications such as gallstones. They say that “regular, life-long, follow-up of all patients” is necessary for all bariatric surgery patients as well as routine mineral and multivitamin supplementation.
I don’t want to paint a distorted picture here of the neurologic risks of bariatric surgery. The “improved memory function” study is from a collaborative group of researchers participating in the Longitudinal Assessment of Bariatric Surgery or LABS project. They point out that “elevated body mass index has been identified as an independent risk factor for Alzheimer’s disease, stroke, and vascular dementia.” Encouragingly, they believe that “obesity-related cognitive dysfunction is at least partly reversible in some persons.”
As I sit here and think of Susie, I want to rush over to her office and ask if she is embracing vitamin and mineral replacement like it is a life ring for her brain. This virtual trip to the National Library of Medicine is yet another screaming wake up call that we all need to advocate for the healthiest diets possible for our families, friends, communities, and nations!
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