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Category: Vitamin B6

Neuromuscular Disease After Weight Loss Surgery

June 08, 2015 11:30 am

Weight loss surgical procedures may result in varying degrees of nutritional deficiencies. Some of these nutritional deficiencies may cause neuromuscular disease if left untreated, these include vitamins, minerals, and protein. The long-term effect of these deficiencies may presents as neuromuscular conditions including, weakness, numbness, confusion and all others if not-diagnosed and untreated. It is important to note that all weight loss surgical procedures require lifetime vitamin, mineral supplements and protein monitoring and possible supplements.

The table below outlines some of the specific neurological and neuromuscular disease complications following bariatric surgery. The most common deficiencies seen with the duodenal switch operation are fat soluble vitamin deficiencies. These include, Vitamin A, D, E and K. Duodenal Switch patients need oral supplements of Dry “Water Miscible” type of Vitamin A, D, E, and K based on their laboratory studies and needs.

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Click on the picture to enlarge
Click on the picture to enlarge

The neurological deficiencies are manifested much more frequently with the Gastric Bypass than the duodenal switch operation. The most common nutritional deficients are that of B1, B12, Folate deficiencies that are common in Gastric Bypass. A list of possible neurologic deficiencies and there associated symptoms were summarized by Becker (2012). Another article with Nutritional Neuropathies.

Nutritional deficiencies are seen in a number of illnesses including weight loss surgery patients.

Vitamin B6 Toxicity

April 01, 2015 7:58 pm

In recent years, we have noticed a trend of increased Vitamin B6 (Pyroxidine) levels in post Duodenal Switch patients’ laboratory studies.  Vitamin B6 is a water soluble vitamin, however, toxicity can happen with an increase in supplementation. The increased availability and amounts of Vitamin B6 in more supplements such as Calcium, multivitamins and B Complex supplements could be the cause of the trend post weight loss surgery.  Please be sure to check the amounts of Vitamin B6 within your daily supplements.

Vitamin B6 Function:

Vitamin B6 is an important water soluble vitamin which functions as co-enzymes in a number of metabolic pathways including  amino acids, fatty acids, glycogen, and steroid hormones (estrogen, cortisol, androgens and Vitamin D) metabolism.  Other biological functions are hemoglobin synthesis, immune function and inflamation, neurotransmission and gene expression. B6 has been shown to improve carpal tunnel syndrome, PMS, AADHD, Alzheimer’s, acne, lung cancer, high homocysteine levels, asthma, kidney sones, and some cases of depression and arthritis.  The U.S. Daily Recommended dose ins 1.2-2mg for adults.

Toxicity has most often happened from increased supplementation and rarely from food alone except for in a subset of people who may have increased sensitivity, gene mutations or other issues with Vitamin B6. In the average person,  doses of 1000mg per day which is about 800 times the daily amount from food can cause neuropathy and neurotoxicity. There have been instances of toxicity issues at doses of 500mg daily. Other symptoms associated with high levels of B6 are skin rashes, nausea, vomiting, loss of appetite, increased liver function tests, sensitivity to sunlight. Nerve damage or numbness and tingling of the feet, legs and hand, if left untreated, can become irreversible.  Stop taking B6 if you experience any of these symptoms.  The daily U.S. no adverse effects dose is set at a max of 200mg  daily. The daily recommend max limit is 100mg daily.

Drug interactions with high doses of B6 levels are phenobarbital, phenytoin and L-Dopa and cause decrease effectiveness.  B6 deficiency is a side effect of oral contraceptives, isoniazid, cycloserine, pencil amine, methylxanthines, and long term NSAIDs use due to impaired Vitamin B6 metabolism.

Once B6 levels are elevated it is important to to try to decrease intake as much as possible and levels will usually drop in weeks to months.  Read your labels of drinks, energy drinks, multi-vitamin, cold supplements, high B6 foods, protein supplements, and other sources.  These are items that typically have added high levels of B6 supplement.  You can also avoid group Vitamin B supplements and go to individual B vitamins that are needed.

Additional information on Vitamin B6. Please have your surgeon or your primary care physician review your laboratory studies. Seek medical attention if you are experiencing any of the above symptoms or any other unusual symptoms.

picture of food with Vitamin B6
Sources of dietary Vitamin B6