Guest blog by: Lillian Craggs-Dino, DHA, RDN, LDN, CLT
Metabolic and bariatric surgery is life-changing, but it also carries risks that require ongoing attention. One such risk is peripheral neuropathy, a condition that affects many after surgery.
In this blog, we explore what peripheral neuropathy is and how you and your healthcare team can work together to prevent it.
Understanding Peripheral Neuropathy
Your nervous system consists of the central nervous system (the brain and spinal cord) and peripheral nerves, which extend throughout your body. Peripheral neuropathy is caused by nerve damage, which can significantly impact your quality of life.
Nerve damage may result from various factors, including injury, medications, illness, surgery, or poor nutrition. After surgery, the risk of nerve damage increases due to changes in how your body absorbs nutrients.
Why Bariatric Surgery Patients Are at Risk
After surgery, you’re educated on diet and supplement recommendations. However, it’s not uncommon to drift from these guidelines for various reasons. It’s important to understand that taking vitamins and eating healthy is not always enough. You need to continually work with your bariatric care team to ensure you are meeting your long-term health goals.
You’re at a greater risk for peripheral neuropathy because the surgery limits your food intake and affects nutrient absorption. Without proper nutrition and supplementation, you could experience nerve damage leading to peripheral neuropathy.
Symptoms of Peripheral Neuropathy
Peripheral neuropathy can be painful and disruptive to your life. Some common symptoms include:
Burning pain
Tingling or numbness in the extremities
Poor balance
Paralysis
Slow-healing wounds
Unfortunately, peripheral neuropathy is common in the United States, especially in people with obesity and diabetes, which are often related to those undergoing bariatric surgery.
Preventing Peripheral Neuropathy Through Nutrition
To prevent peripheral neuropathy, it’s critical to meet your specific post-surgery nutritional needs. Taking a general multivitamin won’t be enough. You should pay close attention to the following micronutrients, which are listed in the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines:
Vitamin E
Vitamin D
Vitamin B12
Vitamin B1 (thiamine)
Vitamin B6
Vitamin B3 (niacin)
Folic acid
Copper
These vitamins and minerals are crucial for maintaining the health of your brain, spinal cord, and peripheral nerves. Deficiencies in one or more of these micronutrients could increase your risk of developing peripheral neuropathy.1
Recommended Micronutrient Dosages and Sources
The table below outlines the recommended starting dosages for key micronutrients2 along with some common food sources:
Micronutrient
Dosage
Foods
Vitamin B12
350-1,000mcg dissolvable, daily OR 1,000mcg monthly injection
All animal protein foods such as eggs, poultry, seafood, red meat
Vitamin B1 (thiamine)
At least 12mg, preferably 50-100mg daily
Brewer’s yeast, pork, yogurt, milk
Vitamin B3 (niacin)
20mg daily (no more than 35mg daily)
Beef liver, shiitake mushrooms, chicken breast
Vitamin B6
2mg daily (no more than 100mg daily)
Cereal, salmon, garbanzo beans, cabbage
Folate (folic acid)
400-800mcg daily OR
800-1,000mcg daily if pregnant or planning on pregnancy
All green leafy vegetables, papaya, nuts and seeds, asparagus
Vitamin E
15mg daily (no more than 1,000mg daily)
Wheat germ, nuts and seeds, avocados
Vitamin D
75mcg daily
Salmon, eggs, cheese
Copper
1-2mg daily (additional may be needed if taking zinc alone) take 1-2mg of copper per 8-15mg of zinc
Oysters, lobster, crab, nuts and seeds, mushrooms
While these dosages are a good starting point, your individual needs may vary. You should regularly have your lab work checked to monitor your nutrient levels and adjust your supplements as needed.
Remember, this is a lifelong process. Work closely with your bariatric interdisciplinary team, including your doctors, dietitians, and specialists, to ensure you meet your nutritional and health goals.
Conclusion
Protecting your nerves after surgery requires paying close attention to your nutritional intake and working with your healthcare team. By following your supplement regimen and keeping up with medical supervision, you can reduce your risk of peripheral neuropathy and maintain a healthy, fulfilling life post-surgery.
References
1. Staff NP et al. Continuum (Minneap Minn). 2014;20(5 Peripheral Nervous System Disorders):1293-1306.2. Mechanick JI et al. Surg Obes Relat Dis. 2020;16(2):175-247.
