Call us today at 281-580-8800 or email us at

Surgeons and physicians should beware of the potential for devastating thiamine/Vitamin B1 deficiency in bariatric patients Contact Now

Bariatric weight loss surgery malnutrition can cause brain damage, Wernicke’s encephalopathy

Surgeons and physicians should beware of the potential for devastating thiamine/Vitamin B1 deficiency in bariatric patients

Bariatric weight loss procedures are a popular option for many people who have problems keeping their weight at a healthy level.

In my experience, many bariatric weight loss surgeons do a great job at selling the potential health and body appearance benefits of surgery, but they downplay—or don’t mention at all—the potential for problems. One of the most common problems is malnutrition.

Bariatric patients have a risk of malnutrition because weight loss surgery alters the anatomy of the gastrointestinal tract. This affects a patient’s ability or efficiency to absorb vitamins and nutrients. That’s why it’s so important for surgeons to counsel patients about nutrition, and for surgeons and physicians to monitor patients closely for signs of a problem.

Wernicke’s encephalopathy

One of the worst possible complications for bariatric-related malnutrition is a life-threatening neurological condition called Wernicke’s encephalopathy. This disorder is linked to a deficiency in thiamine (Vitamin B1).

Physicians diagnose Wernicke’s encephalopathy based on the presence of three classic signs: (1) weak eye muscles (ophthalmoparesis) with uncontrolled eye movements (nystagmus); (2) poor coordination or gait (ataxia); and (3) confusion.

The important take-home message for this devastating disorder is that it can virtually always be prevented if surgeons and doctors treat and pay attention to their patients as individuals, rather than as an assembly line.

Sadly, a middle-aged woman developed Wernicke’s encephalopathy after she had a gastric sleeve procedure. Gastric sleeve surgery is recommended for patients with a body mass index (BMI) of 40 or more. During the surgery, the surgeon permanently removes a portion of the stomach and then stitches the remaining portions of the stomach together. Then end-result looks like a banana shape and reduces the stomach volume.

A full month after the gastric sleeve, this woman continued to suffer from vomiting. This should have been concerning to the bariatric surgeon because it could be caused by multiple potential complications. Additionally, vomiting creates a two-fold nutritional problem for gastric sleeve patients, in that their stomach volume is already decreased, and if they can’t keep food and nutrients down, they can’t be absorbed.

Instead of considering and working on her nutritional status, the surgeon felt it might be gallbladder-related and took her to the operating room to remove her gallbladder (laparoscopic cholecystectomy). After this second surgery, the woman didn’t improve. In fact, the hospital nurses wrote in her medical record that she only ate 10% of her meals and only drank 30 ounces of liquids.

Despite these facts, the doctors decided to discharge her from the hospital—even though the patient couldn’t even eat her breakfast and lunch on the date of discharge. The family raised Cain. They pointed out her poor nutrition and how she had unusual behavior and was confused, as well as cross-eyed. They asked for a doctor to see her, but after three hours no one showed up and they left the hospital.

Within hours of being home, this woman’s condition went downhill. She was very sleepy and weak (lethargic), she had diminished consciousness, was unsteady and off balance when walking, and one of her eyes was closed. The family called 911 and an ambulance took her to a hospital emergency room (ER).

When a neurologist saw her and reviewed labs and a brain CT scan ordered by the ER doctor, he made the diagnosis of Wernicke’s encephalopathy. The treatment? Finally, the healthcare providers paid attention to her nutritional deficits—they started her on intravenous (IV) thiamine (Vitamin B1). An MRI showed brain swelling and a Chiari type 1 malformation, all the fallout from her thiamine deficiency.

After a month in the hospital, this patient was transferred to a neuro rehabilitation facility for brain injury rehab. When she was evaluated by a neuropsychologist, the report documented that she had severe memory problems, impaired ability to learn, jerky and uncontrolled eye movements, and a disordered walk or gait pattern. Despite rehabilitation, these conditions were permanent.

All of this could have been avoided if the surgeon and physicians had simply paid attention to the patient’s nutrition, vitamin replacement, and thiamine levels. Medical experts agreed that the physicians and nursing staff should’ve been aware and on the lookout for the possibility of Wernicke’s encephalopathy, and that it could’ve been easily avoided with proper care.

If you’ve been seriously injured because of poor bariatric weight loss care, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

// Read full biography
// Read more expertise by Robert Painter

Discover More